State of Alabama Unified Judicial System Form C-72 (front) Rev 08/2011 APPLICATION TO BE APPOINTED/RESCINDED AS A MAGISTRATE/WARRANT CLERK Date of Request: I. County of ____________________________________ (City or Town) of _______________________________________ II. Please APPOINT the following; or (a) Municipal Court RESCIND appointment for the following: (b) District Court Magistrate Magistrate Warrant Clerk Mr. Ms. Name _________________________________________ Social Security Number _________________________ Home Address_______________________________________________________________________________ Street City State Zip Code Present Employer ____________________________________________________________________________ Employer's Address __________________________________________________________________________ Mailing City State Zip Code Employer's Telephone Number __________________________________________________________________ Work Email Address____________________________________________________________________ Present Job Title and Duties ____________________________________________________________________ ___________________________________________________________________________________________ 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 designated in numbers (8) through (10) below: (1) Is a resident of the State of Alabama, (2) Is a qualified elector (must be 18 years of age) of the State of Alabama, (3) 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 of one of the above offenses he/she has had his civil and political rights restored by pardon; (4) Has never been adjudicated to be an idiot or insane; (5) 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: (6) Is not a soldier, seaman, or marine in the regular army or navy of the United States; and (7) Does not hold an office of profit under the United States or under this state; NEUTRAL AND DETACHED REQUIREMENT: (8) Is not affiliated with prosecution and police in any manner; (9) Is not in any way assigned to police and subject to the supervision of the chief of police, prosecutor, etc.; and (10) Is not connected with law enforcement activities in any way. ________________________________________________ ________________________________________________ Print or Type Name of Potential Appointee Signature of Potential Appointee IMPORTANT NOTE: If the person being recommended for appointment as a 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. American LegalNet, Inc. www.FormsWorkFlow.com Form C72 (back) Rev 08/2011 APPLICATION TO BE APPOINTED/RESCINDED AS MAGISTRATE/WARRANT CLERK III. I do attest to the fact that the heretofore requested appointee meets all of the above 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 of the U. S. Supreme Court designated in numbers (8) through (10) above. Note: If there is more than one district court judge in the county or more than one municipal court judge in the city or town, each judge must attest that the person is qualified to be a magistrate or warrant clerk by signing below. In addition, the clerk of the district court or the clerk of the municipal court must attest that the person is qualified to be a magistrate or warrant clerk by signing below. Court Clerk ____________________________________ Signature _______________________________________ Court Mailing Address _________________________________________________________________________ Email Address ________________________________________________________________________________ Court Telephone Number _______________________________________________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Judge ____________________________________ Signature _______________________________________ Please Mail Completed Form To: Administrative Office of Courts UJS Magistrate Program 300 Dexter Avenue Montgomery, AL 36104-3741 Email to joy.evans@alacourt.gov or fax to 334.954.3142 American LegalNet, Inc. www.FormsWorkFlow.com