Ill. Admin. Code tit. 14, pt. 176, subpt. K, ILLUSTRATION A
Current through Register Vol. 49, No. 2, January 10, 2025
NONRESIDENT NOTARY PUBLIC
AFFIDAVIT OF APPLICANT
STATE OF
COUNTY OF
I, (name), being first duly sworn, state upon personal knowledge and under penalty of perjury as follows: | |||||
1. The address of my residence is: | |||||
2. I am employed by: | |||||
3. The address of my employer is: | |||||
4. The telephone number at my place of employment is: | |||||
5. The email address at my place of employment is: | |||||
6. The web address at my place of employment is: | |||||
Dated this | day of | , 20 | |||
Signature of Applicant: | |||||
Signed and sworn before me on | day of | , 20 | By | ||
(Printed Name of Applicant) | |||||
(seal) | |||||
Signature of Notary Public | |||||
Ill. Admin. Code tit. 14, pt. 176, subpt. K, ILLUSTRATION A