Please type or print clearly in black ink.
A single copy of the application should be filed.
The application must be signed by the applicant.
The signature of the applicant must be notarized. The
signature and seal of a Notary must appear on the form.
The filing fee must accompany the form. All
applications received without the required fee must be returned to the sender
requesting the proper fee be submitted. Please make all checks payable to the
Secretary of State.