Peter Aldana, Assessor-County Clerk-Recorder County of Riverside INDIVIDUAL REGISTRATION AS AN UNLAWFUL DETAINER ASSISTANT Primary Registration Secondary Registration (File Stamp) Name of Primary County: ____________ Filing Fees: Registration $175.00 File Stamp Bond 7.00 Each additional ID card 10.00 Filing Fee 182.00 Record Bond, first page 15.00 Total Fee Payable to County Clerk $197.00 Each additional page 3.00 If a renewal, a new # must be assigned if there is a lapse of three years or more 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 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 Individual: Business Name: Business Street Address: Business Telephone Number: Name: California Driver's License Number: Date of Birth: Date Bond and Registration Expires: ______________________ Registration Number: ______________ Expiration Date: ______________________ Two years from the date or bond expiration ACR 617 (Rev. 12/2015) Available in Alternate Formats 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Answer each question and check applicable boxes in Sections B, C, D, E, and F B. Civil Judgment Have you 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) Have you had a civil judgment entered against you 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) C. Criminal Conviction (Note: Conviction means a plea or verdict of guilty or a conviction following a plea of nolo contendere. Any conviction dismissed under Penal Code § 1203.4 must be included.) Have you been convicted of a felony? YES NO (Attach certified copies of each conviction/disposition) Have you been convicted of a misdemeanor unlawful practice of law or contempt of the authority of a court under Business and Professions Code §6125 or §6127? YES NO (Attach certified copies of each conviction/disposition) Have you been convicted of a misdemeanor violation of the provisions on legal document assistants and unlawful detainer assistants under Business and Professions Code §6400-6416? YYYES NO (Attach certified copies of each conviction and disposition) D. Revocation of Registration: Have you 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) Are you presently disbarred or suspended from the practice of law pursuant to Business and Professions Code §6100-6117? YES NO Date of Disbarment or Suspension: _____________________________________ E. Disbarment or Suspension: F. Renewal of Registration To be eligible to renew registration, registrant shall complete 15 hours of continuing legal education courses during the two-year period preceding renewal. I have completed the legal education courses required by Business and Professions Code Section 6402.02 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: ______________________________________________________________ Date: ________________________ ACR 617 (Rev. 12/2015) Available in Alternate Formats 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com