Illinois Administrative Code
Title 14 - COMMERCE
Part 176 - NOTARY PUBLIC RECORDS
Subpart K - ADMINISTRATIVE HEARINGS
ILLUSTRATION A - Nonresident Notary Public Affidavit of Applicant

Universal Citation: 14 IL Admin Code ยง ILLUSTRATION A
Current through Register Vol. 48, No. 38, September 20, 2024

NONRESIDENT NOTARY PUBLIC

AFFIDAVIT OF APPLICANT

STATE OF

COUNTY OF

I, (name), being first duly sworn, state upon personal knowledge and under penalty of perjury as follows:

1. The address of my residence is:

2. I am employed by:

3. The address of my employer is:

4. The telephone number at my place of employment is:

5. The email address at my place of employment is:

6. The web address at my place of employment is:

Dated this

day of

, 20

Signature of Applicant:

Signed and sworn before me on

day of

, 20

By

(Printed Name of Applicant)

(seal)

Signature of Notary Public

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