Larry W. Ward, Assessor-County Clerk-Recorder County of Riverside CORPORATION/PARTNERSHIP REGISTRATION AS A LEGAL DOCUMENT ASSISTANT (This space reserved for County Clerk use) Primary Registration Secondary Registration Name of Primary County: _______________ Filing Fees: Registration $175.00 File Stamp Bond 7.00 Each additional ID card 10.00 Record Bond, first page 9.00 Total Fee Payable to County Clerk 191.00 Each additional page 3.00 If a renewal, a new # must be assigned if there is any lapse in the period of registration. APPLICANT INSTRUCTIONS: Completely fill in all personal information requested in Part A. Check each applicable box in Parts B-E and provide information as requested for each box that is checked. Attach legible copies of all documents requested for each box that is checked (attach certified copies and originals as specified). You must sign the completed application under penalty of perjury. A. Business and Personal Information Name of Corporation/Partnership: Business Name: Business Street Address: Business Telephone Number: Name: Name and Date of Birth of each Corporate Officer or General Partner Date of Birth: Name: Date of Birth: Name: Date of Birth: Name: Date of Birth: Name: Date of Birth: Number of Legal Document Assistants employed by the corporation or partnership (check a box): 1 - 4 ($25,000 bond) 5 – 9 ($50,000 bond) Registration Number: ___________________________ ACR 616E-AS4CL0 (Rev. 03/2008) 10 or more ($100,000 bond) Expiration Date:__________________ Available in Alternate Formats 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com B. Education and Experience (This information must be provided for at least one corporate officer or general partner): Name of corporate officer or general partner for whom education and experience information is being provided: ________________________________________________ You must qualify under sections 1, 2, 3, OR 4 and submit required documentation 1. Paralegal program/ABA School I have earned a certificate of completion from a paralegal program that is approved by the American Bar Association (attach copy of certificate of completion). 2. Paralegal Program/Non-ABA School I have earned a certificate of completion from a paralegal program that is institutionally accredited but that is not approved by the American Bar Association (attach copy of certificate of completion). AND I successfully completed a minimum of 24 semester units (or the equivalent) in legal specialization courses (attach copy of transcript). Number of semester units (or the equivalent): __________ 3. College or University I have a bachelor’s degree in ________________________ (attach copy of diploma) (Name of major) AND I have completed at least one year of law-related experience working under the supervision of a licensed attorney (attach original statement on the attorney’s letterhead signed by the attorney describing the scope and dates of your experience) OR I completed at least one year of experience providing self-help service as defined by Business and Professions Code section 6400 (d) before January 1, 1999 (attach original statement describing the scope and dates of your experience) 4. High School or General Equivalence Diploma I have a high school diploma (attach copy of diploma) OR I have a general equivalency diploma (attach copy of diploma) AND I have completed at least two years of law-related experience working under the supervision of a licensed attorney (attach original statement on the attorney’s letterhead signed by the attorney describing the scope and dates of your experience) OR I completed at least two years of experience providing self-help service as defined by Business and Professions Code §6400(d) before January 1, 1999 (attach original statement describing the scope and dates of your experience). Answer each question and check applicable boxes in Sections C, D, or E Note: This information must be provided for each corporate officer or general partner ACR 616E-AS4CL0 (Rev. 03/2008) Available in Alternate Formats 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com C. Civil Judgment Has any officer/partner been held liable in a final judgment or a stipulated judgment entered in a civil action that alleged fraud, use of an untrue or misleading representation, or use of an unfair, unlawful or deceptive business practice? YES NO (Attach certified copy of each judgment) Name of officer/partner for whom judgment information is provided: _____________________________ Has any officer/partner had a civil judgment entered against them in an action arising out of negligence, reckless or willful failure to properly perform obligations as a legal document assistant or an unlawful detainer assistant? YES NO (Attach certified copy of each judgment) Name of officer/partner for whom judgment information is provided: _____________________________ D. Criminal Conviction (Note: Conviction means a plea or guilty verdict or conviction following a plea of nolo contendere. Any conviction dismissed under Penal Code § 1203.4 must be included.) Has any officer/partner been convicted of a felony? YES NO (Attach certified copies of each conviction and disposition) Name of officer/partner for whom conviction information is provided: ____________________________ Has any officer/partner been convicted of a misdemeanor unlawful practice of law or contempt of the authority of a court under Business and Professions Code § 6125 or (Attach certified copies of each conviction and disposition) 6127? YES NO Name of officer or partner for whom conviction information is provided: __________________________ Has any officer or partner been convicted of a misdemeanor violation of the provisions on legal document assistants and unlawful detainer assistants under Business and Professions Code §6400-6416? YES NO (Attach certified copies of each conviction and disposition) Name of officer or partner for whom conviction information is provided: __________________________ E. Revocation of Registration/Disbarment or Suspension Has any officer or partner had a registration as a legal document assistant or an unlawful detainer assistant revoked by a County Clerk under Business and Professions Code § 6413? YES NO (Attach certified copy of each revocation) Name of officer or partner for whom revocation information is provided: __________________________ Is any officer/partner presently disbarred or suspended from the practice of law pursuant to Business and Professions Code §6100-6117? YES NO Date of Disbarment or Suspension: _____________________________________ Name of officer/partner for whom disbarment/suspension information is provided: __________________ I declare under penalty of perjury under the laws of the State of California that all information on this application and on all accompanying documents is true and correct. Signature*: ____________________________________Title: __________________________ Date: ________________________ Signature*: ____________________________________Title: __________________________ Date: ________________________ *Corporate applicant must be signed by the Chairman of the Board or President; or by Vice President and either a Secretary/Asst. Secretary/CFO/Asst. Treasurer. *Partnership applicant must be signed by at least one general partner. ACR 616E-AS4CL0 (Rev. 03/2008) Available in Alternate Formats 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com