| Name |
|
| Firm, Office or Company |
|
| Address |
|
| City |
|
| ZIP |
|
| Telephone |
|
| Home Address |
|
| SSN |
|
| Date of Birth (mm/dd/yyyy) |
|
| Place of Birth |
|
| Marrital Status |
Married
Single
|
| Spouse's First Name |
|
| Colleges & Universities Attended |
|
| Degrees |
|
| Date Admitted to Ohio Bar (mm/dd/yyyy) |
|
| If Admitted To bar of another state(s), Specify state(s), and date(s) admitted |
|
| Have you ever been suspended or disbarred from practice of Law? |
Yes
No
|
| Public offices held by Election or Appointment |
|
| Sponsor (Attorney At Law) |
|
| Sponsor Address |
|
| Sponsor Telephone |
|
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 |
|
| Second Reference with Name, Address, Occupation |
|
| Third Reference with Name, Address, Occupation |
|
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 : $50
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
|
| Above Informations is true And Correct : |
|
|
|
