The following form must be used by an applicant for appointment as a notary public who resides in an adjoining state if the applicant is self-employed:
NONRESIDENT NOTARY PUBLIC
AFFIDAVIT OF SELF-EMPLOYED APPLICANT
STATE OF.............................
COUNTY OF........................
I, ....................(Name of Self-Employed Applicant)...................., being first duly sworn, state upon personal knowledge and under penalty of perjury as follows:
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DATED this..........(day) of....................(month) of......(year)
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Signature of Self-Employed Applicant
Signed and sworn to before me on ........(date)........by....................(Signature of Self-Employed Applicant)....................
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Signature of Notary Public
Nev. Admin. Code § 240.266
NRS 240.017