NOTARY PUBLIC APPLICATION INSTRUCTIONS

As the premier full service notary supply company in Washington State we would like to offer our complete Notary Public processing service to you.

Our service includes; the state required Notary Surety Bond, filing of the bond with the state and the manufacturing of your seal or stamp.

In addition to the basic requirements for becoming a notary we offer a full line of notarial supplies, Notary Errors and Omissions Insurance as well as regularly scheduled training sessions throughout the state.

Begin Your Application Process in Three Easy Steps:

1. Complete the three page State Required Notary Application.

2. Complete the enclosed order form. (This is where you select the seal or stampyou will use for your commission, pay for your State required Notary Bond and theState filing fee of the bond. You may also order additional supplies and pay for aseminar or insurance on this form.)

3. E-mail, fax, or mail the application and order form to our office with thepayment method of your choice.

Once we receive your renewal request we will write your bond and send proof of bonding with the application fee to the state via UPS the next business day.

At the same time we will send you your paid receipt and the original bond with instructions. Enclosed will also be information about how to protect yourself as a notary with Errors and Omissions Insurance & our notary training seminars.

It will take the Notary Section of the State of Washington approximately 3-5 weeks to process your application and issue you a Notary License.

By Law YOU must supply a copy of that license to us before we can begin manufacturing your new seal or stamp. Please allow 4-6 days for the manufacturing and shipping of your supplies.

BOND INFORMATION

Notary PublicAppoinment/ Reappointment Application

This application is a: New application-complete this entire form (pages 2 through 4) Renewal before expiration date-complete sections A and B only (this page)

For Validation only

001-000-256-0001

COMMISSON EXPIRATION DATE:

A Applicant informationNotary Appointment Name (Name as you will sign notarizations and as you would like it to appear on your notary seal/certificate) See page 1 Instructions

Social Security number required* Birthdate (mm/dd/yyyy)

Mailing address (PO Box or street including apartment/suite #, City, State, ZIP code)

(Area code) Telephone number Email

Full legal name (First, Middle, Last) no initials

Check one

I am a Washington resident I work or conduct business in Washington and am a resident of Oregon Idaho

Answer the following

Can you read and write English? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoHave you ever been a Notary Public in the state of Washington? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If yes, under what names?

*All applicants are required by federal and state law to provide their Social Security number (SSN) for use in child support enforcement programs (42 U.S.C. 666(a)(13) and RCW 74.20A.320). It may also be used for education loan repayment programs and identification of records with similar names. Submissionof your SSN is mandatory; failure to submit it will result in denial of your application.

B Personal data

If you answer “Yes,” to any of the questions below, attach a detailed explanation.

In this state or any other jurisdiction are you or have you:

1. Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to agross misdemeanor or felony crime? (Don’t include traffic offenses.) . . . . . . . . . . . . . . . . . . Yes No

2. Currently under indictment, or is there a criminal complaint, charge, or information pendingagainst you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

3. Within the last 10 years, had any action (fine, suspension, revocation, censure, surrender, etc.)taken against any professional or occupational license, certification, or permit held by you? . . . . . Yes No

4. Within the last 10 years, had any civil court order, verdict, or judgment entered against you? . . . . . Yes No

XState of Washington

County of

On this day, , appeared before me, Date Applicant full legal name

signed this Declaration of Applicant, and swore (or affirmed) that he/she understood its contents and that its contents are truthful.

Signature

(Seal or stamp)Printed or stamped name

Title

My appointment expires

Important!You (the Notary Public applicant) must complete this page in front of a Notary Public.

If all of the instructions below are not followed correctly, you will have to complete and submit a new Declaration of Applicant and your Notary Public appointment will be delayed.

Instructions for the applicant1. The Notary Public will properly identify you and place you under oath.2. After the Notary places you under oath, you must:

• Swear to or affirm that the information in the Declaration of Applicant is true.• Print your Notary Appointment Name on the Declaration exactly as it appears in section A of your application.• Sign the Declaration in front of the Notary, using your Notary Appointment Name exactly as it appears in section A of

your application.• Date the Declaration in front of the Notary.

Instructions for the Notary Public1. Confirm the identity of the applicant and place him/her under oath.2. Have the applicant swear to (or affirm) the information in the Declaration of Applicant.3. Have the applicant sign and date the Declaration of Applicant.4. Fill in the name of the county in which you are notarizing.5. Date the Declaration of Applicant. This date must match the date the applicant signed.6. Sign your name exactly as it appears on your stamp or seal.7. Print your name under your signature. Your title is “Notary Public.”8. Fill in the expiration date for your Notary Public appointment.9. Affix your stamp or seal in the space indicated.

Failure to follow any of these instructions by you or the Notary will result in the delay of your license.

D Declaration of applicant

I, , solemnly swear or affirm under penalty of

perjury that the personal information I have provided in this application is true, complete, and correct; that I have carefully read the materials available at the Notary Public website describing the duties of a notary public in and for the state of Washington; and, that I will perform to the best of my ability, all notarial acts in accordance with the law. I have carefully read the questions in the foregoing application and have answered them completely, and pursuant to RCW 9A.72.085, I declare under penalty of perjury under the law of the state of Washington that my answers and all statements made by me herein are true and correct. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for the denial, suspension or revocation of my appointment as a notary public in the state of Washington.

Sign using your Notary Appointment Name Date signed

NP-659-007 (R/3/16)WA Page 4 of 4

Print your Notary Appointment Name exactly as shown in section A of this application

Applicant:sign here in front ofa notary

Name Printed

Address

City

Signature

Type of Identification

Identifying Numbers

Type of Document

DATA INDIVIDUALACKNOWLEDGEMENTIDENTIFICATION

/Date of Act Time of Act Type of Notarial Act:■ Individual Acknowledgement■ Acknowledgement Representative

Type of Representative Capacity■ Verification on Oath or Affirmation■ Witness Signature■ Certifying a Copy■ Certifying an Act or Event■ Other

I, ____________________,affirmed to the Notary Public that I am the person named in the document, and that I have signed it as my free and voluntary act.

I, __________________________________,affirmed to the Notary Public that I am the person named in the document and I swear or affirm that the statements I have made are true.

I, ____________________________, affirmed to the Notary Public that I am authorized to sign the document as the

ofto

be the free and voluntary act of such party.

VERIFICATION ON OATH OR AFFIRMATION

REPRESENTATIVEACKNOWLEDGEMENT

Additional Information:

EMBOSSING SEALS

OLD STYLE IDEAL METAL EMBOSSING SEAL INSERT

NEW STYLE IDEAL HAND HELD/DESK COMBO EMBOSSING SEAL

Complete Seal

Insert Only

RUBBER STAMPS

SELF-INKING IDEAL STAMPS

All inked rubber stamps require re-inking on a regular basis. WARRANTY VOID IF STAMP IS NOT RE-INKED USING APPROPRIATE BRAND OF INK SIZE OF NOTARY STAMPS COMPLIES WITH WASHINGTON STATE NOTARY LAW

NOTARY JOURNALS

ANS JOURNAL OF NOTARIAL ACTS

The three most common Notarial acts require a statement from your customer regarding the contents of the document. (RCW 42.44.080) FOR YOUR PROTECTION the customer signs your book in the appropriate section.

ANS Soft Cover Journal

ANS Hard Cover Journal

STANDARD JOURNAL OF NOTARIAL ACTS

Standard journal should only be used in notarizing documents that are for in-office use only. EXAMPLE: You only notarize the signatures of company officers.

STANDARD Soft Cover Journal

STANDARD Hard Cover Journal

Prudent notaries keep a journal which contains clients’ private information. Use of the Notary Privacy Guard® not only protects the client, but also protects the Notary Public by limiting client’s exposure.

1

3

4

6

8A

B

2

A

B

A B

7REGULAR STYLE RUBBER STAMPS(For Use With A Stamp Pad)

Does Not Include Stamp Pad. These stamps may also be used if working with Mylar and the Mylar stamp pad kit.

A B

C

PRE-INKED SLIM STAMPSW/O HANDLE

A B C

5

A

B

9

10

(For use with the embossing seal only-Black)SEAL IMPRESSION INKER

NOTARY PRIVACY GUARD

INK PADS

For use on paper documents

A B

For use on mylar documents

ATTORNEY & NOTARY SUPPLY Application Order Form

P.O. Box 2895 Renton, WA 98056 ∙ Phone (425) 271-6353 ∙ Fax (425) 271-6396 ∙ www.ansofwa.com THE FOLLOWING INFORMATION IS REQUIRED FOR SHIPPING

Your Name: _______________________________________ Day Phone #:___________________________ Company Name: ____________________________________ Email: _______________________________ Office Mailing Address: _______________________________________________________ Suite: _______ City: ____________________________________ State: ______________ Zip Code: __________________

If the shipping address provided is incorrect, you will be billed for the correction fee. LOST SHIPMENTS WILL NOT BE REPLACED

TAXABLE NOTARY SUPPLIES PRICE QTY TOTAL1. Old Style Metal Embossing Seal Insert 26.502. New Style Hand Held/Desk Combo Embossing Seal

a. Complete Seal 34.50b. Insert Only 26.50

3. Seal Impression Inker, with black or blue ink 17.504. Self-Inking Ideal Stamps

a. Round 39.50b. Rectangular 39.50c. Ink 7.00

5. Pre Inked Slim Stamp, without handlea. Round 41.50b. Rectangular 41.50c. Ink 7.00

6. Regular Style Stamp (stamp pad needed)a. Round 29.50b. Rectangular 29.50

7. Ink Padsa. Black Stamp Pad 7.00b. Mylar Ink Kit 45.00

8. ANS Notary Journala. Soft 18.50b. Hard 26.50

9. Standard Notary Journala. Soft 18.50b. Hard 26.50

10. Notary Privacy Guard 11.9511. Notary Fee Sign 11.0012. Finger Print Pad 8.0013. Self Inking Name/Appointment Expires Stamp (Up to 2 lines) 17.5014. Self Inking Attestation of a Copy Stamp 39.00

Non-Taxable Required Items PRICE QTY TOTALNotary Surety Bond (Required) 50.00 1 50.00State License Fee (Required) 30.00 1 30.00Paper Filing of Notary Bond With the State

Non-Taxable Optional ItemsNotary Training Seminar 135.00$10,000 Notary E&O Insurance (4 years) 40.00$15,000 Notary E&O Insurance (4 years) 50.00$25,000 Notary E&O Insurance (4 years) 60.00$30,000 Notary E&O Insurance (4 years) 70.00$50,000 Notary E&O Insurance (4 years) 100.00$100,000 Notary E&O Insurance (4 years) 200.00

Total of Non-Taxable ItemsTotal Supply Order with Tax & Shipping

TOTAL OF ENTIRE ORDER

Taxable SubtotalShipping & Handling

TAXABLE TOTAL WITH SHIPPING & HANDLING

Call for assistance or visit our website for your current Tax Rate

TOTAL SUPPLY ORDER WITH TAX & SHIPPING

No Charge

Tax- Multiply Taxable Total with the Local Tax Rate

Ink Color

Black Blue Purple

Red Green

Payment Options Payment by Check:

Make Check payable to “A.N.S., Inc.”

OR

Credit Card Info

VISA MC Discover

Card Holder Name ________________________

Card Holder Signature _____________________

Card Number_____________________________

Expiration Date _____ Billing Zip Code _______

Credit Card Charges Cannot Be Cancelled

Shipping Rates Commercial Residential$0-$10 (USPS) $2.50 $2.50$11-$17 (USPS) $5.00 $5.00$18-$30 (UPS) $6.50 $12.50$31-$50 (UPS) $10.50 $14.50$51-$70 (UPS) $13.00 $17.00

Over $70 call for correct charge

SEND COMPLETED ORDER FORM WITH YOU

R BOND

INFORMATION TO: Attorney & Notary Supply, Inc.

PO Box 2895 Renton, WA 98056 OR

renewal@ansofwa.net

3 Digit Code ___________

Did you know that there is more to notarizing than just filling in the blanks?

A notary is an impartial witness to the identity, signature and statement of the person appearing before the notary.

This is why A.N.S. teaches Washington State notary law.

Every notarial act has specific actions which much be followed. Our notary seminars cover the standards for carrying out all notarial acts in Washington.

Notaries are subject to criminal, civil and administrative penalties and your state required notary bond only protects the public you serve. Your only protection is proper training and insurance.

Our seminar is a four hour session concentrating on Washington notary laws and standards. It is taught by practicing Washington Notaries.

President, Judith Welsh, began offering notary seminars to educate Notaries on how to fulfill their notarial duties within the scope of the law after working with the Law Revision Committee in 1985. For over 25 years she has offered year round, statewide notary seminars as well as private group sessions.

Vice President, Rebecca Jacob, joined Ms. Welsh in teaching notary seminars in 1993. Ms. Jacob has used her nearly 30 years of notarial experience to educate notaries on the standards practiced today and has co-written our updated notarial training manual.

Seminar Sessions Have Been Scheduled Statewide Early Sign up is recommended

SEMINAR SESSIONS are from 9:00 a.m. to 1:00 p.m. Check in begins at 8:30 a.m.

REGISTRATION FEE for our four hour session is $135.00. This fee includes all reference materials for our live class as well as a breakfast beverage service. No cancellations accepted within one week of the seminar, although a substitute may be sent.

SEMINAR SCHEDULEALL SESSIONS BEGIN AT 9:00 am AND END BY 1:00 pm

I WILL ATTEND ON (DATE): LOCATION:

NOTARY COMMISSION EXPIRATION DATE: **** CALL FOR APPLICATION FORMS, OR GO TO OUR WEBSITE WWW.ANSOFWA.COM. ATTENDING THE SEMINAR DOES NOTMAKE YOU A NOTARY. YOU MUST COMPLETE THE SEPARATE APPLICATION PROCESS.

ZIP:

(DO NOT USE OFFICE ADDRESS)

DAY PHONE:NAME:

HOME/MAILING ADDRESS:

CITY:

EMAIL ADDRESS:

Enclose a check for $135.00 payable to “ANS of WA, Inc.ALL FEES MUST BE PAID WITH REGISTRATION

NO REFUNDS - THIS IS A CONFIRMED RESERVATION ● Copy this form for your records.

Send Registration and Fees to:

ATTORNEY & NOTARY SUPPLYP.O. Box 2895Renton, WA 98056

If you are paying by Credit CardFax 425-271-6396Email: seminar@ansofwa.net

Credit Card Info

Card Holder Name

Card Holder Signature

Card Number

Expiration Date Billing Zip Code

3 Digit Authorization Code

MC

Credit Card Charges Cannot be Cancelled

VISA Debit Credit

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