STATE OF SOUTH CAROLINA

OFFICE OF THE SECRETARY OF STATE

THE HONORABLE MARK HAMMOND

Change in Status Form-Resignation

No Filing Fee

For Office Use Only

Date Received

Date Updated

Pursuant to s.c. Code of Laws §26-1-140(B), when a notary ceases to reside in South Carolina or becomes

permanently unable to perform his or her duties, the notary shall resign his or her commission and notify the

Secretary of State of the resignation using the Change in Status Form. Please type or print in black or blue

ink.

I, _____________________ resign my commission as a notary public effective

(name as commissioned)

as of: __________________________________________________________

(effective date of resignation)

Please provide your date of birth: __________________________________________

Sworn to and subscribed before me

This _________ day of ____________

_________________________________

Notary Public of South Carolina

My Commission Expires: ____________

Date

Printed Name of Applicant

Signature of Applicant

*Please sign here using your name as commissioned.

Filing Instructions

1. Return by mail or hand delivery to:

Secretary of State

Attn: Notary Division

1205 Pendleton Street Suite 525

Columbia, SC 2920J

2. This form must be signed and notarized. You cannot notarize your own signature, but must have it notarized by

another notary.

3. 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 at tsharpe@sos.sc.gov

4. Please allow approximately 10 days for processing.