STATE OF SOUTH CAROLINA OFFICE OF THE SECRETARY OF STATE THE HONORABLE MARK HAMMOND

Change in Status and Duplicate Commission Request Fonn

Filing Fee: $10.00

For Office Use Only

Date Received

Date Updated

Please check the appropriate option(s) and complete the information as required You will only need to complete the sections relevant to your change ofinformation. Please type or print in black or blue ink.

The applicant is requesting the following:

oNotary Public Name Change If requesting a name change, please provide the following information:

I (please print) Changed From: Changed To:
I Name
(as commissioned)

Name Changes: Once you have received your new notary public commission bearing your new name

.fi'om the Secretary ofState's Office, you may offiCially begin notarizing documents in your new name as issued on your commission. Pleuse enroll your new commission in your new name with YOUl' countv's Clerk ofCourt. You will need a new seal that reflects your name change. You also need to destroy or deface any seals bearing your old name so they cannot be misused. The expiration ofyour term as a notmJl public will remain the same as il was prior to your name change.

oNotary Public Address Change

If requesting a change to any of the following, please complete the applicable portions:

(please print) Mailing Address: Mailing Address I City: Mailing Address , Zip Code: , Home Street Address: Home Address I City: Home Address Zip Code: County: I Changed From: I i, , Changed To: I I I I i
Phone:
IEmail Address: I I

Address Changes: Following a change ofaddress or contact information, the expiration dale of your term as a notary public will remain the same. You are not required to make any changes TO your seal. You will not receive a new commission h'hen you make an address change unless you have also changedyour name or requested a duplicate copy ofyour commission. Ifvou have moved to a new count)" VOli must enroll pOllr commission with the Clerk ofCourt in that countv.

oDuplicate Copy of Notary Public Commission

Duplicate Copies: You may request a duphcate copy ofyour commission at any time.lfyou have changedyour name, you will receive a new commission and do not need to request a duplicate

commission.

Please provide your date of birth: ________

Sworn to and subscribed before me Date This __ day of ______, ___.

Printed Name of Applicant

Notary Public of South CaroHna Signature of Applicant My Commission Expires:

*Plea..,e sign here using your name as commissioned. If

you are changing your nameJ please sign using your new

name as it is printed abOl'e and will be commissioned.

Filing Instructions

I. Return by mail or hand delivery to: Secretary of State Attn: Notary Division 1205 Pendleton Street, Suite 525 Columbia, SC 2920 I

  1. Please make checks payable to the South Carolina Secretary of State,

  2. Include the $10.00 filing fee. The total fee for this fonn is $10.00, even if more than one option is selected.

  3. S.c. Code of Laws §26-1-130 states a notary must notii); the Secretary of State of any changes to the notary's legal name, address, or county within 45 days of the changers) using a Change In Status Fonn as prescribed by the Secretary.

  4. This fonn must be signed and notarized. You cannot notarize your own signature, but must have it notarized by another notary.

  5. The Notary Public Division is open from 8:30 a.m. to 5:00 p.m., Monday through Friday, except on state holidays. To contact the Secretary of State's Notary Division. call (803) 734-2512, You may also contact the Division Director, Tracy Sharpe, by email attsharpe@sos.sc.gOv.

  6. Please allow approximately 10 days for processing.