State of Alabama Unified Judicial System Form C-73 Rev 05/2011 DISTRICT COURT MAGISTRATE OR WARRANT CLERK APPOINTMENT * IN THE DISTRICT COURT OF (Name of County) , ALABAMA Date of Appointment Date Oath Administered Date Oath Filed with Probate Judge Information on Potential Appointee Name: Work Address (including city, state and zip code): Present Job Title & Duties: Home Address Alabama Social Security Number : I certify that I meet all of the following requirements established by law for public officers; designated in numbers (1) through (7) below, and that I am neutral and detached from law enforcement as mandated by decisions of the U. S. Supreme Court and designated in number (8) through (10) below: (1) (2) (3) Is a qualified elector; Is a resident of the state, circuit, district, or county; Has never been convicted of treason, embezzlement of public funds, malfeasance in office, larceny, bribery, perjury or any other crime punishable by imprisonment in the state or federal penitentiary, or, if the person has been convicted of one of the above offenses, he/she has had his civil and political rights restored by pardon; Has never been adjudicated to be an idiot of insane; Does not have any unpaid judgment against him/her for any moneys received by him/her in any official capacity due to the United States, this state, or any County or Municipality thereof; Is not a soldier, seaman, or marine in the regular Army or Navy of the United States; and Does not hold an office of profit under the United States or under this state; NEUTRAL AND DETACHED REQUIREMENT Is not affiliated with prosecution and police in any manner; Is not in any way assigned to police or subject to the supervision of the chief of police, prosecutor, etc., and Is not connected with law enforcement activities in any way. (4) (5) (6) (7) (8) (9) (10) Print of Type Name of Potential Appointee Signature of Potential Appointee IMPORTANT NOTE: If the person being recommended for appointment as a district court magistrate or warrant clerk intends to serve as both a district court magistrate or warrant clerk and a municipal court magistrate, the person, if appointed, can be paid for only one position; otherwise, the appointee will be considered as holding two offices of profit in violation of Article XVII, §280, Constitution of Alabama of 1901. I do attest to the fact that the heretofore requested appointee meets all the requirements established by law for public officers, designated in numbers (1) through (7) above, and is neutral and detached from law enforcement as mandated by decisions by the U. S. Supreme Court and designated in numbers (8) through (10) above. I hereby appoint as District Court Magistrate or Warrant Clerk to serve and perform the duties of such office, under my supervision. Print or Type Name of Circuit/District Clerk Court Address City State ZipCode Signature of Circuit/District Clerk *Only to be used for appointment of individuals Currently within the district court clerk's office to Serve as district court magistrate or warrant clerk. Email Address Please return completed form to: Administrative Office of Courts, UJS Magistrate Program 300 Dexter Avenue, Montgomery, AL 36104-3741 or Fax to Joy Evans 334.954.3142 Email to joy.evans@alacourt.gov American LegalNet, Inc. www.FormsWorkFlow.com