Name - Print or type your name as you want it to appear on your commission certificate. You are required by law to use your full last name, while initials may be used for first and middle names. Date of Birth - Please provide your birth date in numerals: month/day/year. This is to confirm that applicants are at least 18 years of age.

Home Address - Please provide the address at which you reside. If your mail goes to a post office box, please include a street address after the PO Box number. Also give the city, state and zip code.

County of Residence - Please indicate the county in which you legally reside or your regular place of work.  You are commissioned for the county in which you live or your regular place of work as a Missouri resident.  You are able to notarize anywhere in the state of Missouri. If you reside in St. Louis City, please put St. Louis City in the county blank.

Daytime Phone Number - You are requested to provide a phone number where we can reach you BETWEEN THE HOURS OF 8:00 a.m. and 5:00 p.m., should we need to verify information given on the application. E-mail Address - Please provide your e-mail address.

Employer / Name of Business - Your employer’s name is requested should we need to contact you during working hours. If unemployed, please enter “N/A” or enter “Self-employed” if you own your own business.

Missouri Commission Number - If reapplying, please provide your Missouri commission number.

Previous Commission Expiration Date - Please provide if reapplying.

Name - Print or type your name as you want it to appear on your commission certificate. You are required by law to use your full last name, while initials may be used for first and middle names. Date of Birth - Please provide your birth date in numerals: month/day/year. This is to confirm that applicants are at least 18 years of age.

Home Address - Please provide the address at which you reside. If your mail goes to a post office box, please include a street address after the PO Box number. Also give the city, state and zip code.

County of Employment - Please indicate the county where you are employed. If you work in St. Louis City, please enter St. Louis City.

Daytime Phone Number - You are requested to provide a phone number where we can reach you BETWEEN THE HOURS OF 8:00 a.m. and 5:00 p.m., should we need to verify information given on the application. E-mail Address - Please provide your e-mail address.

Employer / Name of Business - Your employer’s name is requested should we need to contact you during working hours. If unemployed, please enter “N/A” or enter “Self-employed” if you own your own business.

Missouri Commission Number - If reapplying, please provide your Missouri commission number.

Previous Commission Expiration Date - Please provide if reapplying.