One Gateway Center, Suite 401
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420 Fort Duquesne Boulevard
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Pittsburgh, PA 15222-1498
800.944.8790
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fax: 800.707.7075
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pan@notary.org
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www.notary.org
Pennsylvania Association of Notaries
Dear PAN Customer,
If you are a PAN member, please send your notary application to the Pennsylvania
Association of Notaries, One Gateway Center, Suite 401, 420 Fort Duquesne
Blvd., Pittsburgh, PA 15222. You can also E-mail your application to: notaryapp@
notary.org or fax it to PAN at 1-800-707-7075.
Non-members
, please submit your notary application along with a check or money
order payable to “Commonwealth of Pennsylvania” for $42 and a copy of your ed-
ucation certificate to: The Department of State, Commonwealth of Pennsylvania –
Department of State, Bureau of Commissions, Elections and Legislation, Division
of Legislation and Notaries, 210 North Office Building, Harrisburg, PA 17120.
NOTE: Your completed application must be submitted within six months of com-
pleting the education requirement. Please allow six to 10 weeks for the Secretary’s
office to process your application.
Thank you.
Commonwealth of Pennsylvania – Department of State
Bureau of Commissions, Elections and Legislation
Division of Commissions, Legislation and Notaries
210 North Office Building
Harrisburg, PA 17120
Tel: (717) 787-5280 Web: dos.pa.gov/notaries
NOTARY PUBLIC APPLICATION
(Revised 10/14/2016 and
effective 10/26/2017)
PRINT OR TYPE CLEARLY. FILL OUT APPLICATION COMPLETELY. Do not leave any blanks.
Use “none” or “N/A” if applicable. An incomplete application will delay your appointment.
FEE: $42 – make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
CHECK ONE: New Appointment
Reappointment
(have been a notary in Pennsylvania before)
PART I: Applicant Information (NOTE: Employer/Business contact information will be public record)
First Name
Middle Name or Initial (if used)
Last Name
Date of Birth (mm/dd/yyyy)
Social Security Number (xxx-xx-xxxx)
Email Address
Name of Employer/Business where Notary Commission will be used (Do not leave blank. If not applicable, please indicate.)
Employer/Business Street Address (P.O. Box alone is insufficient)
City
State
Employer/Business Telephone (include area code)
County
Home Street Address (P.O. Box alone is insufficient)
City
State
Zip Code
Home Telephone (include area code)
County
Part II: Education; Criminal, Disciplinary and Legal History (Check or mark appropriate boxes)
YES (√)
NO (√)
I am a notary applicant for initial appointment or reappointment and I have completed a three-hour notary public education course, pre-
approved by the Department, within the six-month period immediately preceding this application. I have attached a copy of my course
completion certificate and retained my original. Lack of proof of education will result in application rejection.
Have you ever been convicted or accepted Accelerated Rehabilitative Disposition in resolution of a felony or misdemeanor preceding
the date of this application? Conviction includes a finding of guilt by a court or jury, a plea of guilty or nolo contendere or a finding of not
guilty due to insanity or of guilty but mentally ill. If yes, attach full details (name of court, plea/conviction/ARD, sentence and length of
probation) and appropriate supporting documents with a signed and dated personal explanation.
Have you ever resigned a notary commission or had a notary commission suspended, revoked or otherwise disciplined by the
Commonwealth of Pennsylvania or any other state/jurisdiction preceding the date of this application? If yes, attach full details and
appropriate supporting documents with a signed and dated personal explanation.
Have you ever had any other professional or occupational license suspended, revoked or otherwise disciplined?
If yes, attach full details and appropriate supporting documents with a signed and dated personal explanation.
Have you ever had a judgment levied against you or admitted liability in a legal proceeding for your actions as a notary public?
If yes, attach full details and appropriate supporting documents with a signed and dated personal explanation.
Note that disclosing your social security number on this application is mandatory for the Department of State to comply with the requirements of the federal Social Security Act pertaining to
child support enforcement, as implemented in the Commonwealth of Pennsylvania at 23 Pa. C.S. § 4304.1(a). To enforce domestic child support orders, the Commonwealth’s licensing
boards must provide to the Department of Human Services (DHS) information prescribed by DHS about the licensee, including the social security number.
APPLICANT AFFIDAVIT: I am at least 18 years of age; a citizen or permanent legal resident of the United States; a resident of or have a place of employment in
Pennsylvania; able to read and write English. I meet all the qualifications for appointment and commission as prescribed by law and have the honesty, integrity,
competence and reliability to act as a notary public. I shall furnish additional evidence of these statements, if requested, which shall be satisfactory to the Department of
State. To the best of my knowledge and belief, this application contains no misrepresentations or falsifications, omission or concealments of material fact and the
information given by me is true and complete. I understand that any false statement made is subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn falsification
to authorities) and may result in the suspension, revocation, or denial of my notary commission.
________________________________________________________ _________________________________________________ _______________________________
Applicant Signature (must match name in Part I) Applicant Printed Name (must match name in Part I) Date
If you have ever been a notary in Pennsylvania before or used a different name:
Notary commission expiration date
Full name on previous commission
Notary commission ID number
Other name used on previous commission or other/former name(s) you have used
PENNSYLVANIA NOTARY PUBLIC APPLICATION – INSTRUCTIONS
To qualify for appointment and commission as a Pennsylvania Notary Public, you MUST:
• Be at least eighteen (18) years of age
• Be a citizen or permanent legal resident of the United States
• Be a resident of Pennsylvania or have a place of employment or practice within this Commonwealth
• Be able to read and write English
• Have completed at least three hours of approved notary education within the six months immediately preceding your application (see below for more information)
• Pass an examination (for applicants who do not hold a current and active commission – see below for more information)
• Have the honesty, integrity, competence and reliability to act as a notary public – this is generally the absence of a conviction of, or acceptance of Accelerated
Rehabilitative Disposition, by the applicant for a felony or an offense involving fraud, dishonesty or deceit
• Not be otherwise disqualified to receive a commission
The following persons are NOT eligible to hold the office of Notary Public:
• Any member of the Congress of the United States, and any person, whether an officer, a subordinate officer or agent holding any office or appointment of profit or
trust under the legislative, executive, or judicial departments of the government of the United States, to which a salary, fees or perquisites are attached.
• Any member of the General Assembly of Pennsylvania.
Notary Public Application Procedures
General Instructions: This application must be TYPEWRITTEN or PRINTED legibly. Applications will be accepted only on the form approved for use by Department of
State. This form may not be altered in any way. Do not send a copy of your completed form; only the original will be accepted. All answers are subject to investigation and
false statements (including omissions) will be deemed as adequate grounds for rejection.
PART I: Use your full name as you would like it to appear on your commission. Nicknames will not be accepted. You may use any of the following: full first name and last
name; full first name, middle initial and last name; full first name, full middle name and last name; first name initial, full middle name and last name. Your signature at the
bottom of the application must match the full name printed in this section. Your commission will be prepared and issued in this name. If applicable, employer business
information may be the same as home address information (i.e., home office). Note that a home office address and telephone number listed in the employer/business
address section of the application will become public information.
PART II: Answer all questions. Where “yes” is checked, supply full details and appropriate supporting documents with a signed and dated personal explanation.
Signature: The applicant’s signature on the application must exactly match the applicant’s name as provided on the application. The applicant shall use a legible,
recognizable handwritten signature, which can be attributed to the applicant by anyone examining or authenticating the signature. A signature is legible and recognizable if
it is distinct, easily readable and understandable, and the notary’s full name may be clearly discerned by looking at the signature. If an applicant’s preferred signature is
not legible and recognizable, the applicant must also legibly print his or her name immediately adjacent to his or her preferred signature.
To ensure uninterrupted “commissioned” status, completed applications for reappointment should be submitted to the Department of State AT LEAST TWO TO
THREE MONTHS prior to the expiration of the current commission. Renewal applicants should allow AT LEAST ONE MONTH for processing after submitting a completed
renewal application to the Department.
New appointees should allow AT LEAST FOUR TO SIX WEEKS for processing after submitting a completed application to the Department of State. If notice of
appointment is not received within this time, contact the Bureau at the address at the top of the application.
Fee: Each application must be accompanied by a check or money order for $42.00, made payable to “Commonwealth of Pennsylvania,” and mailed to 210 North Office
Building, Harrisburg, PA 17120. The fee is non-refundable. The Department of State is authorized to revoke the notary public commission of a notary public who issues a
personal insufficient funds check to the order of any State agency or the Commonwealth.
Oath of Office, Bond, Recording: Upon appointment, the Department of State will send notice of appointment to the applicant, with further instructions and an official
bond and oath form to be executed by the applicant. These materials will be sent to the applicant’s business address as provided on the application. The applicant should
record the commission, executed bond and oath form in the Recorder of Deeds in the county where their office is located. This must be completed within FORTY-FIVE
(45) DAYS after the date of appointment or the commission becomes null and void. Extensions will not be given.
All correspondence from the Department of State concerning your notary public application, notice of appointment to office and bond
will be mailed to the employer/business address you have provided on your application. Your name, employer/business name,
employer/business address, employer/business telephone number and commissioning history will become public information. If you
list your home address, “N/A” or “None” in the employer/business address section of the application, your home address and home
telephone number will become public information.
NEW Mandatory Education Requirement for all applicants – The Revised Uniform Law on Notarial Acts, Act 73 of 2013 (effective October 26, 2017),
requires all applicants for both initial appointment and reappointment as a notary public to complete at least three hours of approved notary education within the six
months immediately preceding the application for appointment or reappointment. Under the new law, the exemption previously available for notaries whose
commission was in effect on July 1, 2003 is abolished. All notaries public are required to complete an approved notary education course in order to be appointed or
reappointed, including those notaries previously “grandfathered” from the prior education requirement by court ruling.
NEW Examination Requirement for applicants who do not hold a current notary commission – The Revised Uniform Law on Notarial Acts (effective
October 26, 2017) requires all applicants who do not hold a current commission in Pennsylvania to pass an examination. This includes applicants who have never
held a notary commission and all applicants who previously held a notary commission but whose commission has expired at the time their application for appointment
is received by the Department. Upon approval of the application, applicants who are required to take the examination will be provided with information on the
computer-based testing procedures and sites.