Page 1 of 3 ELAINE F. MARSHALL STATE OF SECRETARY OF STATE DEPARTMENT OF THE SECRETARY OF Certification and Filing Division Office of Notary Investigations and Enforcement P.O. PHONE: 919-814-5400 FAX: 919-807-2210 E-MAIL: WEBSITE ADDRESS: WWW.SOSNC.GOV COMPLAINT FORM The Department has the authority to investigate complaints against any North Carolina Notary when there is an allegation or appearance of violation of Chapter 10B of the North Carolina General Statutes, any rule adopted or any order issued pursuant to this Chapter. Instructions: Please provide detailed information, be specific and compose clear, concise answers. Please furnish copies of any documents or other materials relating to this complaint. If additional space is needed attach separate sheets and reference the item. Please type or print clearly. COMPLAINANT INFORMATION USE TAB OR ARROW KEY DATE OF FULL NAME: BIRTH: First Middle Last MM/DD/YYYY ADDRESS: STATE: ZIP: CITY: BUSINESS PHONE: HOME PHONE: FAX NUMBER: CELL E-MAIL: INFORMATION ABOUT THE NOTARY WHICH YOU ARE FILING A COMPLAINT AGAINST If more space is needed please attach additional pages and reference the item as Information” “Notary Notary Name Title/Position Notary Address Phone No. DBA OR OTHER NAME OF NOTARY’S NAMES IT USES, IF EMPLOYER: ANY: ADDRESS OF ORGANIZATION: CITY: STATE: ZIP: PHONE: CELL PHONE: FAX NUMBER: E-MAIL:
ELAINE F. MARSHALL SECRETARY OF STATE Page 1 of 3 STATE OF DEPARTMENT OF THE SECRETARY OF Certification and Filing Division Office of Notary Investigations and Enforcement P.O. PHONE: 919-814-5400 FAX: 919-807-2210 E-MAIL: WEBSITE ADDRESS: WWW.SOSNC.GOV COMPLAINT FORM The Department has the authority to investigate complaints against any North Carolina Notary when there is an allegation or appearance of violation of Chapter 10B of the North Carolina General Statutes, any rule adopted or any order issued pursuant to this Chapter. Instructions: Please provide detailed information, be specific and compose clear, concise answers. Please furnish copies of any documents or other materials relating to this complaint. If additional space is needed attach separate sheets and reference the item. Please type or print clearly. COMPLAINANT INFORMATION USE TAB OR ARROW KEY FULL NAME: DATE OF BIRTH: First Middle Last MM/DD/YYYY ADDRESS: CITY: STATE: ZIP: HOME PHONE: BUSINESS PHONE: CELL FAX NUMBER: E-MAIL: INFORMATION ABOUT THE NOTARY WHICH YOU ARE FILING A COMPLAINT AGAINST If more space is needed please attach additional pages and reference the item as “Notary Information” Notary Name Title/Position Notary Address Phone No. NAME OF NOTARY’S EMPLOYER: DBA OR OTHER NAMES IT USES, IF ANY: ADDRESS OF ORGANIZATION: CITY: STATE: ZIP: PHONE: CELL PHONE: FAX NUMBER: E-MAIL:
notary_complaint_form.docx