Illinois Notary Application The application wizard makes it easy for you to complete your Illinois Notary application without errors! You’ll be able to save your progress to your NNA profile and print it at your convenience, or download a blank application instead. If you are applying for an Illinois non-resident Notary commission, you must use this form. When completed, you must PRINT, SIGN AND MAIL your application to: National Notary Association, 9350 De Soto Avenue, Chatsworth, CA 91311-4926. 1Applicant Information Notary Name Required * Your Name must match your driver’s license/ID card. First Name * Middle Name or Initial Last Name * Business Address The State of Illinois requires a physical address. Enter "N/A" or "Self Employed" for business address if none. Required * Street * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming ZIP Code * Identifying Information Required * Name of Employer * Date of Birth * Drivers License orState Identification Card Number * Verify Drivers License or State Identification Card Number * Home Address The State of Illinois requires a physical address. Required * Street * City * State * Illinois ZIP Code * County of Residence * Select County Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland Dekalb Dewitt Douglas Dupage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox La Salle Lake Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac Mcdonough Mchenry Mclean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saint Clair Saline Sangamon Schuyler Scott Shelby Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford Contact Information Required * Email Address * Home Phone * Business Phone * 2Commission Information Required * Which are you applying for? * A New Commission Renewal of Commission Adding Electronic Notary to Active Notary Public Commission Commission Expiration Date * Commission Number * Are you requesting a Notary Public and Electronic Notary Public Commission? * Yes No Name(s) of Electronic Notarization System Provider(s) * Type of Device(s). Check all that apply. * Desktop Computer Laptop Smartphone Tablet Other Other Device * Have you had any disciplinary actions, convictions or administrative actions against you? * Yes No Please provide the type of action or conviction, date of same, name of the court or agency that took the action, and State of the action. If there are multiple, list each on a separate line. * Has your name, address or county changed since your last commission? * Yes No Please give the previous name, address and/or county * Will you perform Notarizations remotely by means of Audio-Video Communication? * Yes No 3Qualifications & Oath Qualification Statements Required * I am a U.S. citizen or an alien admitted for permanent residence.* I have been a resident of Illinois for at least 30 days.* I am age 18 or older.* I have never been convicted of a felony.* I am able to read and write the English language.* I have never had a notary public commission revoked.* Notarial Oath Required * I do solemnly affirm, under the penalty of perjury, that the answers to all statements on this application are true, complete and correct; that I have carefully read the notary law of the State of Illinois; and that if appointed and commissioned as a notary public, I will perform faithfully, to the best of my ability, all notarial acts in accordance with the law. Further, my signature below authorizes the Office of the Secretary of State to conduct a background verification to confirm the assertions and information provided herein.*