Notary Handbook - the Montana Secretary of State Website

Montana Secretary of State
Certifications and Notary Services
PO Box 202801
Helena MT 59620-2801
MONTANA NOTARY PUBLIC
03/12 CONTACT INFORMATION UPDATE No Charge
Indicate the item(s) to be changed:
Name** New City of Residence ** Home Mailing Address Physical Address
Employment Information Home/Cell Telephone Number Work Telephone Number Email Address
Your name as it appears on your current Certificate of Commission:
_______________________________________________________________________________________________________________________
Email address ___________________________________________________
Commission expiration date _________________________
(Month/Day/YYYY)
For name-change requests only (You MUST submit a rider or endorsement from the bonding company with this form.)
Your New Name**:
______________________________________________________________________________________________
New Home Mailing Address: New Home/Cell Phone Number: New Email Address:
_________________________________________________________ _______________________________ _________________________________
Street/Box #
Apt/Unit
City _____________________________________ County _______________________________________ State MT Zip _______________
New Physical/Residence Address (if different):
_____________________________________________________________________ __________________________________________
Street
Apt/Unit
City** _____________________________________ County____________________________________ State MT
Zip _____________
New Employment Information:
New Work Phone Number:
____________________________________________________________________
Employer Name
______________________________________________
_____________________________________________________________________________________________________________________
Employer Address City State Zip Code
SIGNED_______________________________________ (sign with new name, if applicable)
DATE_________________________________________
** An Amended Certificate will be issued for requested name and city of residence changes only. You must order a
new seal/stamp with the updated information when you receive your new certificate.
DO NOT ORDER YOUR NEW SEAL/STAMP UNTIL YOU HAVE RECEIVED YOUR AMENDED CERTIFICATE OF COMMISSION!
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