Cheatham County, Tennessee



APPLICATION FOR TENNESSEE NOTARY PUBLICCHEATHAM COUNTY, TENNESSEEThis application, when duly executed in front of a Notary, must be submitted to the County Clerk at least ten (10) days prior to the meeting of the County Legislative body. If approved, a Bond must be posted in the amount of Ten Thousand dollars (10,000). The Bond must be filed with office of the county Clerk along with a filing fee of $19.00. When these requirements are met, the Secretary of State will issue the Notary Publics for the State of Tennessee Commission for a term of four years. All questions relate to mandatory requirement of election. (T.C.A. 8-16-101 § et seq.).APPLICATION MUST BE PRINTED OR TYPEDNotary Name (Name that will appear on notary stamp) – NAME MUST MATCH SIGNATURE BELOW_______________________________________________________________________________________________________ Last First Middle name or Initial ONLY IF USED ON NOTARY STAMPResidence Address: _______________________________________________________________________________________Business Address: ________________________________________________________________________________________Residence Phone: __________________________________ Business Phone: ________________________________________DATE OF APPLICATION _____/_____/_____PLEASE ANSWER THE FOLLOWING QUESTIONS WITH YES OR NOAre you a resident of Cheatham County or do you have a principal place of Business in Cheatham County? ________________Have you ever been convicted of offering or giving a bribe, larceny, or any other offense declared infamous by law? _________If the answer to the previous question was YES, has your citizenship been restored? ___________________________________Is there an unpaid judgment against you for money received in an official capacity and due to the United States, to Tennessee, or any Tennessee county, or are you a defaulter to the treasury? __________________________________________________Are you a soldier, seaman, marine, or airman in the regular Army, Navy, or Air Force of the United States, a member of the United States Congress, or a person holding any office of profit or trust under any foreign power, other state or the United States? _________________________________________________________________________________________________Have you ever been removed from office as a notary public for official misconduct? ___________________________________Have you ever had a notary commission revoked or suspended by this or any other state? ______________________________Have you ever been found by a court of this state or any other state to have engaged in the unauthorized practice of law? ____Is there any other reason that you are legally disqualified from holding the office of a notary public? ______________________I DO SWEAR AND AFFIRM UNDER PENALTIES OF PERJURY THAT THE STATEMENTS ABOVE ARE TRUE AND CORRECT.Signature of Applicant: ____________________________________________________________________________________(SIGNATURE MUST MATCH NOTARY NAME ABOVE)APPLICANT’S SIGNATURE MUST BE NOTARIZEDState of TennesseeCounty of ______________________________Sworn to and subscribed before me this __________day of ____________________, 20____Notary: ______________________________________________________________________________________My commission expires: ________________________________________________________________________ ................
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