State of Wisconsin
Four-Year Notary Public
Commission Application
OFFICE USE ONLY
COMMISSION DATE:
Fee: $20.00
1. Is this your first Wisconsin commission? Yes No If “No,” indicate the most recent expiration date: __________________
2. If the name on your last commission has changed and you have not notified us, list former name(s) here:
3. Current
Full Name:
First
Middle
Last
Suffix
4. Mailing
Address
In Care of: (Business Name, if applicable)
Street Address or PO Box
City
State
Zip Code
5. Email Address (For contact and/or emailing the commission certificate)
6. Date of Birth (MM/DD/YYYY)
7. Phone Number (Best number to contact)
8.
Place a clear impression of seal/stamp sample here. If
impression is not clear, apply sample and signature to
plain white paper and include with this application
.
11. Have you ever been convicted of a felony in
Wisconsin and/or the United States?
Yes No If “Yes,” submit documentation
of the conviction(s) and indicate current status of the
conviction(s).
12. To the Department of Financial Institutions: I hereby
apply for a four-year appointment as a Wisconsin Notary
Public. I certify that I am a United States resident, educated
with regard to the duties and responsibilities of a Notary
Public, and that I have at least the equivalent of an eighth
grade education, and that all of the information I have
provided is true.
Applicant Signature
_________________________________
Email or mail completed application to:
DFINot[email protected]
Mailing Address:
Notary Records Section
WI Dept of Financial Institutions
PO Box 7847
Madison WI 53707-7847
Contact us:
Call: 608-266-8915
Fax: 608-264-7965
Submit:
• Completed application
• Notary Bond
• $20.00 (if not already
submitted electronically)
• Oath of Office
• Notary Exam Certificate
9. Sign your name exactly as it appears on your seal/stamp
10. Print your name exactly as it appears on your seal/stamp
First
Middle
Last
Suffix
DFI/NOT/100 (R04/17) Page 1 of 4
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Digital Signatures are NOT allowed
Digital Signatures are NOT allowed
State of Wisconsin
Department of Financial Institutions
Notary Records
Four-Year Notary Public Commission
Application Instructions
This document may be made available in
alternative formats upon request to
qualifying individuals with disabilities.
You may NOT perform notarial acts until you are notified by the Department of Financial Institutions
that the commission has been issued or reissued in the case of a reappointment.
General Requirements:
In order to become a Notary Public under Wisconsin Statute §137.01, you must be a resident of the United States, 18
years of age or older, have at least the equivalent of an eighth grade education, pass the online Notary Public exam
(https://www.wdfi.org/apps/NotaryTutorialExam/TableOfContents.aspx
) with 90% or better, (this can be taken an
unlimited number of times until you pass) and have demonstrated adherence to laws according to Wisconsin Statutes with
regard to arrests/citations/convictions. (Note that under current law, persons convicted in state or federal court of a felony,
or persons convicted of a misdemeanor involving a violation of the public trust, may not be commissioned as notaries
public for the State of Wisconsin unless they have been pardoned of the conviction.)
You must purchase:
an engraved official seal or official rubber stamp that only contains “State of Wisconsin,” “Notary Public” and your printed name
that must include your full current last name. No title such as “Dr.” or “CPA” should appear before or after your name.
a $500.00 bond.
Please keep in mind that when performing a notarial act you must always sign your name exactly as set forth on your
seal/stamp. An application submitted with an un-clear seal/stamp impression or with additional non-notary seals affixed,
cannot be accepted for filing and will be returned. Be certain your seal/stamp impression is still totally clear and legible. If
necessary, affix the impression on a separate piece of paper and attach it to your application. Do not affix other seals/stamps (those
showing county or expiration dates) on the application form, as these seals/stamps are not considered “official” notary seals, and
therefore, may not be affixed on the application.
Instructions for the Four-Year Notary Application
1. Indicate the expiration date of your most recent Wisconsin notary commission unless this is your first commission.
2. If you had a previous notary commission in Wisconsin and your name has changed, enter your former name(s).
3. Enter your current full legal name (first, middle, last and suffix (Jr, Sr, if applicable).
4. Enter your complete mailing address. Use “In Care Of” only if the mailing address is a business address.
5. Please enter your email address to receive communication regarding your notary application and commission
certificate. You may wish to add “DFINotary@wisconsin.gov” to your contacts to prevent the email from being sent
to a spam folder.
6. Enter your date of birth.
7. Enter your phone number with the area code. If you have an extension, enter that after your phone number.
8. Affix a clear impression of your notary seal/stamp in the space provided. (If the impression/stamp leaves an unclear mark, affix
additional samples on a separate white sheet of paper and include the paper with your application.).
9. Sign with your official notary signature using the exact spelling as shown on your notary seal/stamp.
10. Enter your name exactly as signed (and as the name appears on the seal/stamp).
11. Answer “Yes” or “No.” Attach an explanation if you answered “Yes”.
12. Read the statement and apply your original signature.
You must complete and submit the following:
Four-year Notary Public Commission Application Notary Bond Form Oath of Office Form
Certificate from passing the Notary Exam with 90% or better (www.wdfi.org/apps/NotaryTutorialExam/TableOfContents.aspx),
taken within 1 year of the date of submission of the application.
$20 filing fee made payable to the Wisconsin Department of Financial Institutions (if not already submitted electronically)
Email or mail completed application to: Contact us:
DFINotary@wisconsin.gov
Notary Records Section Call: 608-266-8915
WI Dept of Financial Institutions Fax: 608-264-7965
P. O. Box 7847
Madison WI 53707-7847
NOTICE: You are hereby informed that the information you provide on the application may be considered a public record available for
public inspection. Wisconsin Statutes require that you provide written notice of any change of address to the Wisconsin Department of
Financial Institutions within 10 days of the change. Grounds for revocation of your commission may include: providing false information
on this application, submitting an application fee which is unredeemable due to insufficient funds or conviction for certain crimes while
holding a commission.
DFI/NOT/100 (R04/17) Page 2 of 4
State of Wisconsin
Department of Financial Institutions
Notary Records
Oath of Office
Four-Year Notary Public Commission
Notary Applicant Section (person applying for a four-year notary public commission):
***IN THE PRESENCE OF A NOTARIAL OFFICER***
Complete lines 1 and 2. Do not notarize your own signature!
I do solemnly swear that I will support the Constitution of the United States and the Constitution of the State
of Wisconsin, and will faithfully discharge the duties of the office of Notary Public, in and for the State of
Wisconsin, to the best of my ability; that I am a resident of the United States, and am 18 years of age or
older.
1. Notary Applicant Signature: ____________________________________________
2. Notary Applicant Printed Name: _________________________________________
Notarial Officer Section (person who administers the oath to the applicant, and watches the applicant sign):
Complete lines 3-9. Officer who signs line 6 may not be the applicant who signs line 1.
3. State of _____________________________ 4. County of __________________________
5. Subscribed and sworn to before me on this day (MM/DD/YYYY): ______________________
Note: The name and signature in numbers 6, 7 and 8 must be spelled exactly the same.
6. Signature of Notarial Officer: ____________________________________________
7. Print name of Notarial Officer: ___________________________________________
8. Seal/Stamp of Notarial Officer
9. Check only ONE box:
□ Notarial Officer is a Notary Public whose commission
expires on _________________.
OR
□ Notarial Officer is a Notary Public whose commission is
Permanent.
OR
□ Notarial Officer is not acting as a Notary Public but as
authorized by Section 706.07 or 887.01, Wis. Stats.,
with this title:
_________________________________________
DFI/NOT/100 (R04/17) Page 3 of 4
Digital Signatures are NOT allowed
Digital Signatures are NOT allowed
State of Wisconsin
Department of Financial Institutions
Notary Records
Bond Instructions
All persons applying or reapplying for a four-year notary public commission must purchase a $500 bond from an
insurance company. Contact the insurance company of your choice to purchase a bond. This bond form, or a bond form
supplied by an insurance company, must be completed and submitted to the Wisconsin Department of Financial
Institutions as proof that you have purchased a bond. Any bond form supplied by an insurance company must be in a
format previously approved by DFI. The insurance company you choose to supply your bond must be qualified to write
surety bonds in Wisconsin.
Notary Applicant: Complete sections 1-6. Section 1 must be an original signature.
Insurance Agent: Complete sections 7-13. Sections 9, 10, and 11 must indicate the surety company’s information rather
than the local insurance agency’s name and address. For section 13, if a seal or stamp is affixed, the name of the surety
company on the seal or stamp must match the name listed in section 9. If a power of attorney form is used, the agent’s
name as signed in section 7 must appear on the power of attorney.
Notary Public Bond
KNOW ALL TO WHOM THESE PRESENTS SHALL COME, that we (notary applicant and surety), jointly and severally,
undertake and agree that the notary applicant, upon appointment to the office of Notary Public, will faithfully discharge the
duties of said office according to law, and that the surety will pay to the parties entitled to receive the same, such
damages, not exceeding the aggregate FIVE HUNDRED DOLLARS ($500) as may be suffered by them in consequence
of the failure of the notary applicant herein to discharge his or her duties as a Notary Public.
Notary Applicant – Complete 1 – 6 Insurance Agent – Complete 7 – 13
1.
Signature of notary applicant
7. Signature of surety company agent
2.
Print name of notary applicant
8. Print name of person who signed #7
3.
In care of: (Business name, if applicable)
9. Print name of surety company
4.
Mailing address of notary applicant
10. Mailing address of surety company
5.
City State Zip
11. City State Zip
6.
Daytime telephone of notary applicant
12.
Date
After this form has been completed, email or mail it in
the same envelope along with your completed
application, Notary exam certificate, Oath of Office,
and $20 filing fee (if not already paid online) to:
Notary Records Section
WI Dept of Financial Institutions
PO Box 7847
Madison WI 53707-7847
Questions?
Email: [email protected]
Call: 608-266-8915
Fax: 608-264-7965
13.
Surety company seal, stamp or power of attorney
must be affixed.
DFI/NOT/100 (R04/17) Page 4 of 4
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Digital Signatures are NOT allowed
