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Affirmation for Appointment and Commission as a Notary Public
Colorado Secretary of State
Notary Program
1700 Broadway, Ste. 200
Denver, CO 80290

I,

Phone: 303-894-2200, press 4, then 1
Email: [email protected]

, solemnly affirm, under the penalty of

Print legal name

perjury in the second degree, as defined in section 18-8-503, Colorado Revised Statutes, that I have
carefully read the notary law of this state, and if appointed and commissioned as a notary public, I
will faithfully perform, to the best of my ability, all notarial acts in conformance with the law.
I am (mark one):
a United States citizen.
not a US citizen, but am a legal permanent resident of the United States.
not a US citizen or legal permanent resident, but am lawfully present in the United States
pursuant to federal law.
I understand that this sworn statement is required by law because I have applied for a public benefit. I
understand that state law requires me to provide proof that I am lawfully present in