| Name |
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| Firm, Office or Company |
|
| Address |
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| City |
|
| ZIP |
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| Telephone |
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| Home Address |
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| SSN |
|
| Date of Birth (mm/dd/yyyy) |
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| Place of Birth |
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| Marrital Status |
Married
Single
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| Spouse's First Name |
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| Colleges & Universities Attended |
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| Degrees |
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| Date Admitted to Ohio Bar (mm/dd/yyyy) |
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| If Admitted To bar of another state(s), Specify state(s), and date(s) admitted |
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| Have you ever been suspended or disbarred from practice of Law? |
Yes
No
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| Public offices held by Election or Appointment |
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| Sponsor (Attorney At Law) |
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| Sponsor Address |
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| Sponsor Telephone |
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Name, Address and occupations of three references
(Exclusive of Sponsors / Relatives), Preferably Members of Bench, Bar of Law School Faculty |
| First Reference with Name, Address, Occupation |
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| Second Reference with Name, Address, Occupation |
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| Third Reference with Name, Address, Occupation |
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Payment In Full For One Year's Dues Must Accompany Application
DUES :
1st Full Calender Year After beeing sworn in :$0
1st - 10th year of practice : $70
11th - 49 th year : $100
50th year and over : $0
Retired and less than 50 years as
attorney : $50
Lifetime : $2000
Paralegal/Legal Assistant : $50
REMIT PAYMENT TO:
GREENE COUNTY BAR ASSOCIATION
3rd floor Greene County Courthouse
45 N. Detroit Street
Xenia, OH 45385
(937) 562-5040
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| Above Informations is true And Correct : |
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