J.P.Everhart & Company Inc.
1840 N. Greenville Ave., Suite 178
Richardson, TX 75081
888-622-8575

INFORMATION NEEDED TO PRE-FILL YOUR APPLICATION
FOR APPOINTMENT AS TEXAS NOTARY PUBLIC

Identifying Information
Name to be used as notary public:

Last

First

Middle

Suffix
- -
Social Security No
Mailing Address:

Street

City

State

Zip
Residence County
Email: Telephone:
Date of Birth: / / Driver's License or Identification No: Issuing State:
Is this application for renewal? Yes No If YES, current commission expiration date: / /
An application for renewal may only be submitted within 90 days before expiration of a current commission.

Statements Relating to Qualifications
 I, the above named applicant, am at least 18 years and a legal resident of Texas.
Select one of the following:
A. I have been found guilty of a crime other than a class C misdemeanor. Applicants selecting this option must attach
the following for each crime: (1) copies of court order and sentence, and papers pertaining to release from probation;
and (2) a statment of (i) the nature, circumstances, date, and location, and (ii) whether the case is on appeal.
B. I have never been found guilty of a crime (other than a class C misdemeanor).
C. I have never been found guilty of a crime.
Your pre-filled application will arrive via email for your signature.

Application For Notary Errors and Omissions Insurance Is Here!
DON'T GO UNPROTECTED

Did You Know Notary Bonds Protect the Public, Not the Notary?

State statutes regulate and prescribe the duties of a Notary Public. Professional liability is imposed on the Notary Public and, in most states, there is a mandatory bond requirement to protect the public from losses caused by a Notary acknowledging a signature improperly.

But What About Your Legal Liability?

When performing the functions of a Texas Notary Public, the Notary Bond protects the public but does not cover your legal liability. Your professional liability can easily be $10,000 or more, and your legal defense fees can be substantial even if the claim against you is dismissed. This financial expense can be insured at a minimal cost.

Southern Insurance Company Can Protect You!

A Texas Notary Public professional liability policy will protect you against claims for negligent acts, errors or omissions committed or alleged to have been committed when acting in the capacity as a Notary Public, subject to all terms and conditions of the policy. Your LEGAL DEFENSE is also covered even if the suit is groundless, false or fraudulent. Protect yourself and sign up for Errors and Omissions Insurance today!

Limits of Liability 4 Year Premium
$5,000 Aggregate $25.00
$10,000 Aggregate $40.00
$15,000 Aggregate $50.00
$25,000 Aggregate $60.00
No Thank You - I Decline Coverage at this time.
Applicant's Statement:
Do you know of any circumstances that might result in a claim being made against you as a result of your services as a Notary? Yes No
Has a claim ever been made against you as a result of your services as a Notary Public? Yes No
Agent:J.P. Everhart & Co., Inc.
Agent Number:089 06323
For complete terms and conditions call 1-888-622-8575 or go to our website at www.JPEverhart.com.