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STATE OF SOUTH CAROLINA OFFICE OF THE SECRETARY OF STATE THE HONORABLE MARK HAMMOND Notary Division 1205 Pendleton Street Suite 525 Columbia SC 29201 803 734-2512 803 734-1116 Request for Duplicate Notary Public Commission or Change of Name of Notary Public The applicant is requesting the following Please check the appropriate box or boxes. Duplicate Copy of Notary Public Commission this includes pocket card - 10. 00 Notary Public Name Change - 10. 00 COUNTY OF To Secretary of State of South Carolina Name on original application IF requesting a name change enter new name here Present Address City and Zip Code Last 4 Digits of Social Security Date of Birth EMAIL Voter Registration Date Signature of Applicant Sworn to and subscribed before me this day of 20 Please sign here exactly as you will sign when you notarize documents. Notary Public of South Carolina My Commission expires MAIL REQUEST FORM AND CORRECT FEE TO THE ABOVE ADDRESS. Duplicate Copy of Notary Public Commission this includes pocket card - 10. 00 Notary Public Name Change - 10. 00 COUNTY OF To Secretary of State of South Carolina Name on original application IF requesting a name change enter new name here Present Address City and Zip Code Last 4 Digits of Social Security Date of Birth EMAIL Voter Registration Date Signature of Applicant Sworn to and subscribed before me this day of 20 Please sign here exactly as you will sign when you notarize documents. 00 COUNTY OF To Secretary of State of South Carolina Name on original application IF requesting a name change enter new name here Present Address City and Zip Code Last 4 Digits of Social Security Date of Birth EMAIL Voter Registration Date Signature of Applicant Sworn to and subscribed before me this day of 20 Please sign here exactly as you will sign when you notarize documents. Notary Public of South Carolina My Commission expires MAIL REQUEST FORM AND CORRECT FEE TO THE ABOVE ADDRESS. Duplicate Copy of Notary Public Commission this includes pocket card - 10. 00 Notary Public Name Change - 10. 00 COUNTY OF To Secretary of State of South Carolina Name on original application IF requesting a name change enter new name here Present Address City and Zip Code Last 4 Digits of Social Security Date of Birth EMAIL Voter Registration Date Signature of Applicant Sworn to and subscribed before me this day of 20 Please sign here exactly as you will sign when you notarize documents. Notary Public of South Carolina My Commission expires MAIL REQUEST FORM AND CORRECT FEE TO THE ABOVE ADDRESS.

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