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COMPLAINT ALLEGING |
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UNAUTHORIZED EXERCISE OF NOTARIAL POWERS |
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La. R.S. 35:601 et seq. |
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RETURN COMPLETED FORM TO: |
Tom Schedler |
Secretary of State Notary Division, |
Secretary of State |
P.O. Box 94125 |
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Baton Rouge, LA 70804 |
Parish of _____________________________
Before me, the undersigned authority came and appeared the undersigned complainant, who in accordance with the provisions of La. R.S. 35:603, and being duly sworn, did depose and say that
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_______________________ is in violation of the |
Printed name of subject of complaint |
Notary ID# if known |
following provision(s) of La. R.S. 601 et seq. (UNAUTHORIZED EXERCISE OF NOTARIAL POWERS)
Violation(s): check all that apply
_____ Commission or authority to exercise notary function is statutorily or judicially suspended.
_____ Commission or authority to exercise notary function is statutorily or administratively revoked.
_____ No longer validly commissioned.
_____ Commission in retirement status under provisions of R.S.35:202(G)
_____ No longer validly possessed of the office or position from which authority to exercise notarial functions were derived.
_____ Convicted of a felony and has not been pardoned.
_____ Not authorized by law to exercise that particular notarial function.
_____ Engaged in dishonesty, fraud, deceit, or misrepresentation.
_____ Certified as true what he knows or should have known to be false.
_____ Violated any provision of any law governing the office of notary or the exercise of notary authority.
_____ Abandoned his commission.
_____ Failed to pay over money entrusted to him in his official capacity as a notary public.
_____ Failed to satisfy any final judgment rendered against him in his official capacity as a notary public.
_____ Not authorized to exercise notarial powers.
Complainant’s statement to include details of violation(s), its nature, the dates, time(s), address(es) where violation(s) occurred and address of subject of the complaint. (attach additional page(s) if necessary):
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Complainant name:_________________________________________ Phone: _________________________________
Complainant address: _______________________________________ City, State, Zip:__________________________
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Signature of Complainant
Sworn to and subscribed before me this ____ day of ___________, 20___
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Signature of notary
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