FOR OFFICIAL STATE BAR USE ONLY THE STATE BAR OF CALIFORNIA Member Services Center 180 Howard Street · San Francisco, CA 94105-1617 (888) 800-3400 · msc@calbar.ca.gov Amount Received $ Check # No Check Received Certificate Request Form Foreign Address Please use a separate request form for each member Initials 1) MEMBER/REQUESTOR INFORMATION Member‟s Full Name: (Mr./Ms.) Member Number: Requestor‟s Name (if other than member): E-Mail: Phone Number: 2) DELIVERY INFORMATION: Firm/Agency Name: Attention: Address: City: State: Country: + Zip: 3) ORDER INFORMATION You may request up to 3 total copies per member, in any combination below, for your payment of $25. Please send me a regular certificate of standing (not notarized). Number of copies: Please send me a foreign jurisdiction certificate. Number of copies: . If paying by check, also include a money order (no personal checks) in the amount of $10 per certificate made payable to “The UPS Store” to cover notary fees (please be sure your member number and phone number are included on the money order). Please allow for extra processing time. Please send a complaint check certificate. Complaint check certificates may only be sent to state bar associations and state supreme courts. I authorize the State Bar of California to release any information related to my disciplinary record to the state bar or court listed above: Signature: Please be aware that certificates required for admission to the U.S. Supreme Court must be purchased from the California Supreme Court (See instructions at www.calbar.ca.gov for details). 4) SHIPMENT INFORMATION FAX CREDIT CARD ORDERS TO: Member Services Center (415) 538-2576 Please mail my certificate(s). (Note: Certificates cannot be faxed) For an extra fee, please send my certificate(s) by UPS delivery. Shipping and Handling charges: $15 charge for domestic $30 charge for foreign OR MAIL TO: Member Services Center 180 Howard Street San Francisco, CA 94105-1617 Please allow for up to three days for processing, regardless of shipping type. 5) PAYMENT INFORMATION Pay by Check: Make check payable to „The State Bar of California‟ Pay By Credit Card Card #: VISA - MasterCard - WE DO NOT ACCEPT AMERICAN EXPRESS - Expiration Date (MM/YY): / Name on Card: Billing Address: By my signature below, I hereby authorize The State Bar of California to charge my VISA or MasterCard account for the cost of the certificate(s) as well as any shipping or notary charges requested above. Signature: 2011MSCCertStandingReq1011 Date: American LegalNet, Inc. www.FormsWorkFlow.com Certificate Request Form Instructions for Requesting a Certificate of Standing Regular Certificates – Requests for regular certificates must be made in writing. For a fee of $25, you may request a maximum of 3 certificates per member (See form for details). Please include the bar number to ensure the certificate is for the correct person. The certificate cannot be faxed, but will be mailed within 5 working days of receipt of the request. Certificate includes – Full name, date of admission, name changes (if any), changes of status (Inactive, Not Eligible, etc.), and discipline (if any). Complaint Check Certificates – If you are applying for admission to another state, you may be asked to provide information as to whether or not complaints or grievances have been filed against you. These certificates may only be sent directly to the state supreme court or state bar of the other state. They cannot be sent to the member or to any other individual or organization. To obtain a COMPLAINT CHECK CERTIFICATE, send a certificate request form and a check for $25 to the Member Services Center. The request must include the signature of the member authorizing the release of such information, and the address of the state supreme court or state bar that will be receiving the certificate. Foreign Jurisdictions – If you need a certificate that is also notarized for admission in another country, send the certificate request form and fee, and include the information that it must be notarized. Include a contact phone number so that we can make the necessary arrangements. You are responsible for payment of notary fees. You should include a money order in the amount of $10 for each certificate to be notarized, made payable to “The UPS Store”, or your credit card will be charged. Please allow for extra processing time for Foreign Jurisdiction Certificates to be notarized. California Supreme Court Certificate – Some jurisdictions (the U.S. Supreme Court) require a certificate from the California Supreme Court. These may be obtained from the court with a written request and a fee of $1. Send your request, payment and self-addressed envelope to: California Supreme Court 350 McAllister St., Room 1295 San Francisco, CA 94102 (415) 865-7000 For questions about the procedure for obtaining Certificates of Standing, contact the Member Services Center at 1-888-800-3400 or msc@calbar.ca.gov. 2011MSCCertStandingReq1011 American LegalNet, Inc. www.FormsWorkFlow.com