Authorization And Release Form. This is a Alabama form and can be use in Alabama Bar Association Statewide.
Tags: Authorization And Release, Alabama Statewide, Alabama Bar Association
AUTHORIZATION AND RELEASE TO WHOM IT MAY CONCERN: Re Application of: Name of Registrant or Applicant I, having filed an application with the Alabama Board of Bar Examiners and fully recognizing the responsibility to the Public, the Bench and the Bar of this State lodged with the Alabama Board of Bar Examiners by the Supreme Court of Alabama under the Constitution of the State of Alabama to determine that only those of high character and ability are admitted to the Bar of Alabama, hereby authorize and request every medical doctor, school official, and every other person, firm, officer, corporation, association, organization or institution having control of any documents, records or other information pertaining to me relevant to my good moral character and fitness to perform the responsibilities of an attorney, to furnish the originals or copies of any such documents, records and other information to said Board, or any such documents, records and other information including but not limited to any and all medical reports, laboratory reports. X-rays, or clinical abstracts which may have been made or prepared pursuant to, or in connection with, any examination or examinations, consultation or consultations, test or COURT tests, evaluation or evaluations, of the undersigned. COUNTY .OF. . . . . . . . . . . . . . . hereby. authorize .all .such . . . . . . as. set .out. above .to .answer .any .inquiries, questions or interrogatories concerning the under . I ... persons . . . . . . . . . . . . . . . . . . : signed which may be submitted to them by the Alabama Board of Bar Examiners or its authorized representative, and to appear before said Index No. Board, or its authorized representative, and to give full and complete testimony concerning the undersigned, including any information furnished by the undersigned. I hereby relinquish any and all rights to said reports, including but not limited to clinical abstracts, consultations, : Calendar No. evaluations, or any other information incident in any way to cooperation with the Alabama Board of Bar Examiners, or its authorized representative, and fully understand that I shall not be entitled to have disclosed to me the contents of any of the foregoing. : JUDICIAL SUBPOENA Plaintiff(s) I hereby release and exonerate every medical doctor, school official, and every other person. firm, officer, corporation, association. organization or institution which shall-against- good faith with the authorization and request made herein from any and all liability of every comply in : nature and kind growing out of or in anywise pertaining to the furnishing or inspection of such documents, records and other information or the investigation made by said Alabama Board of Bar Examiners. The undersigned further waives absolutely any privilege he/she may have relevant to his/her good moral character and fitness to perform the responsibilities of : attorney under the laws of Alabama, Rules of Court, an and such other regulations as may be promulgated governing the practice of law in the State of Alabama. : In witness whereof, I have set my hand and seal this __________ day of 20 Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature.of . . . . . . . . . Applicant THE PEOPLE OF THE STATE OF NEW YORK STATE OF_ TO COUNTY OF GREETINGS: CERTIFY that on this day personally appeared before me. an officer duly authorized to I HEREBY administer oaths and take acknowledgements_____________________________________________________________ you attend before WE COMMAND YOU, that all business and excuses being laid aside, you and each of to me well known to be the person described in and who executed the foregoing instrument and he/she acknowledged before me that he/she the Honorable at the Court executed the same freely and voluntarily for the purposes therein expressed. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the WITNESS my hand and official seal at (city) and State of County of this the day of _________ 20 Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Notary Public result of your failure to comply. My commission expires Witness, Honorable Court in County, , one of the Justices of the day of , 20 CERTIFICATE All forms of Authorization and Release executed by student registrants and applicants for admission into the name below) (Attorney must sign above and type Alabama Bar Examination shall terminate immediately upon admission to the Alabama State Bar or within 60 days of the total and absolute withdrawal of an application by the applicant from any examination. I. Keith B Norman. as Secretary of the Alabama Board of Bar Examiners, hereby certify that the above-referenced registrant or Attorney(s) or applicant been admitted to the Alabama applicant has not notified this Board of the termination of his/her application nor has the registrant for State Bar. Office and P.O. Address Date. Secretary, Alabama Board of Bar Examiners Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: October 1994 American LegalNet, Inc. www.USCourtForms.com ,