OFFICE OF THE SECRETARY OF STATE

APPLICATION FOR APPOINTMENT AS AN ALABAMA CIVIL‑LAW NOTARY

Form ACLN‑1

Effective xxxxxx xx, xxxx

Full Name: ____________________________________________________________

1. (Last)                       (First)                  (Middle)

   Date of Birth: ____/____/____       Alabama Bar ID Number: ____________

   Place of Employment:  _________________________________________________

   Business Address:     _________________________________________________

   (Street)

   _________________________________________________

2. (City)                      (State)        (Zip Code)

   Residence Address:    _________________________________________________

   (Street)

   _________________________________________________

3. (City)                      (State)        (Zip Code)

   Home Phone: (   )_____________       Business Phone: (   )_____________

   FAX Number: (   )_____________       E‑mail Address: __________________

   Please attach to this application:

   1) A certificate of good standing from the Supreme Court of Alabama issued within 90 days of this application, showing that you are currently a member of the Alabama Bar and have been a member of the Alabama Bar for at least 5 year;

   2) An application processing fee in the amount of $100.00.

   CERTIFICATION

   I hereby certify that the information indicated on this application is true and accurate and that I understand any false statements herein constitute a violation of $13A‑10‑102, Code of Alabama (1975). I further certify that I am eligible to be appointed an Alabama Civil‑law Notary, and that my name appears on this application as an Alabama Civil‑law Notary.

   _________________________________________________________________

   (Print of Type Legal Signature of Applicant)

   _________________________________________________________________

   (Legal Signature of Appointee as it will appear on notarial acts)

   _________________________________________________________________

4. (Date)

   Office of Secretary of State · P.O. Box 5616 · Montgomery, Alabama 36103‑5616