DECLARATION OR CERTIFICATION

(After the 6 hrs of study, complete and submit this form)

DECLARATION OR CERTIFICATION UNDER PENALTY OF PERJURY

Notary Pros 6 Hour Self-Study

Note: You must submit this Declaration or Certification in order to receive your Proof of Completion to satisfy the Secretary of State's mandatory 6 hour course completion.

The form must be filled out in it's entirety and mailed, faxed or electronically transmitted to Notary Pros. 150 W. Santa Ana Ave, Bloomington, CA 92316 or faxed to (909) 421-0792 or e-mailed to: irene@notaryproseminars.com. Once you have returned this form, your proof of completion will be issued within 24 hours.

Astericks are required fields

My Name is:

*ID Type: Drivers License Military Passport

*ID Number:

* ID Expiration Date:

* ID Issuing State:

*First Name on ID:

Middle Name on ID:

*Last Name on ID:

1. The identification information I provided to Notary Pros for this
course is true and accurate.

2. I am the course attendee as noted above and that I, alone have
proceeded through this outline course for its entire duration.

3. I have completed the approved 6 (six) hour course of study
     offered by Notary Pros regarding the laws and regulations that
     apply to California notaries public. This includes reading and
     for at least 6 (six) hours the course materials and taking any
     practice exams included as part of the course. I completed the 6
     (six) hour course of study on    Date: *
                                           please enter date

4 I* hereby declare or certify under penalty of
                 please type name
      perjury under the laws of the State of California that these
      statements are true and correct.

5.   I understand that the crime of perjury is punishable by
      imprisonment in the State prison for two, three or four years
      (Penal Code §126).

6. I agree to be bound by the above statements.

7. Your e-mail address: *

8. Mailing Address: *

PLEASE COMPLETE AND SUBMIT THE SURVEY BELOW

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