Teresa Jacobs
3258 Highway 126
Suite 101
Blountville, TN 37617
Phone: 423-323-6428
Fax: 423-279-2725
Web: www.SullivanCountyClerkTN.com
Sullivan County
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Other Locations:
225 West Center St.
Kingsport, TN 37660
Phone: 423-224-1790
Hours: M-F, 8am - 5pm
801 Anderson St.
Bristol, TN 37621
Phone: 423-989-4366
Hours: M-F, 8am - 5pm
Notary Public Application
By submitting this application you hereby certify under penalty of perjury that all information contained herein is true and correct, and that you are 18 years of age or older. Once approved and elected, you must then be commissioned by the Governor. In addition, you will be required to post a bond in the amount of $10,000. This bond must be filed in the office of the County Clerk where you will pay the required fees and take the oath of office. You are not an authorized notary public until you have received your commission from the Governor, filed your bond, and taken the oath of office. You must be a United States Citizen or a legal permanent resident of the United States. Should you move your residence or your principal place of business out of this county, you are required to notify the County Clerk of the change of address, and you must pay a fee of $2.00.
Please Answer ALL Following Questions
Date of Application: 10/16/2018
Full Name:
Notary Name:
Notary First Notary Middle Notary Last Notary Suffix
 Applicant's Printed Name Exactly As You Wish To Appear On Notary Seal
Home Address:
Employed By:  
Business Address:
Corporate Bond:  
Individual Bond 1:   Must be approved by county commission.
Individual Bond 2:   Must be approved by county commission.
Home Phone: - -
Business Phone: - -
Date of Birth: (FORMAT: MM/DD/YYYY)
Email Address:
Answering Yes to any of the following questions will disqualify this Notary Application
1. Have you ever been convicted of offering and/or giving a bribe, larceny, or any other offense declared infamous by law?
2. If you answered question 1 with YES, has your citizenship been restored?
3. Is there an unpaid judgment against you for moneys received in an official capacity, due to the United States, to Tennessee, or to any of its counties?
4. Are you a defaulter to the treasury?
5. Are you serving as a soldier, sailor, marine, or airman in the Regular Army, Navy, or Air Force of the United States?
6. Are you a member of Congress, or a person holding any office of profit or trust under any foreign power, other state of the union, or under the United States?
7. Have you ever been removed from office of Notary Public for official misconduct?
8. Have you ever had a notarial commission revoked or suspended by Tennessee or any other state?
9. Have you ever been found by a court of Tennessee, or of any other state, to have engaged in the unauthorized practice of law?
10. Is there any other reason that you are legally disqualified from holding the office of a Notary Public?
Were ANY of the previous questions Yes?   Yes No
Legal Binding Disclaimer:
This Notary Application is a legal binding document between you and Sullivan County.
Select Type:
Commission only - No Stamp $20.00
Payment Information:
Application Fee $
Convenience Fee $1.00
Credit Card Fee (2%) $0.00
Total $
Credit Card Information:

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