Form Not-2
Rev 7/1/02
STATE OF NEW JERSEY
NOTARY PUBLIC NAME and/or ADDRESS CHANGE FORM
This statement must be filed whenever a NOTARY PUBLIC adopts a name and/or address change different
from that which was used at the time the commission was issued and
BEFORE
signing any document
authorized or requested to be sign as a NOTARY PUBLIC.
This statement must
ALSO
be filed in the office of the county clerk in which the Notary Public may have filed
the certificate of the commission and qualification.
IDENTIFICATION NO. COMMISSION DATE EXPIRATION DATE
PLEASE PRINT OR TYPE ALL INFORMATION BELOW
FULL NAME OF NOTARY
PREVIOUS FULL NAME OF NOTARY
ADDRESS OF NOTARY
(INCLUDE COUNTY)
PREVIOUS ADDRESS OF NOTARY
(INCLUDE COUNTY)
SET FORTH CIRCUMSTANCES AND DATE BELOW UNDER WHICH NEW NAME WAS ADOPTED (I.E.,
MARRIAGE, DIVORCE, COURT ORDER, ETC.)
REASON DATE
I HEREBY CERTIFY THAT THE ABOVE FACTS ARE TRUE AND CORRECT AND THE SIGNATURE
PROVIDED BELOW IS TRUE AND CORRECT.
NAME DATE
The fee is $25.00 for name changes only. there is no charge for a change of address. Your cancelled check , an
is your receipt. If you need written proof of these changes, an additional $1.00 will be assessed and a check for
ALL CHECKS SHOULD BE MAILED TO:
DIVISION OF REVENUE
NOTARY PUBLIC SECTION
PO BOX 452
TRENTON, NJ 08646
$26 should be submitted.
