RANDOLPH COUNTY COURTHOUSE FACILITY

APPLICATION FOR ATTORNEY

 

 

 

 

NAME OF APPLICANT___________________________________________________

                                                    LAST                                      FIRST                                                M.I.

 

 

DATE OF BIRTH_________________________

 

NAME OF LAW-FIRM_____________________________PHONE#_______________

 

BUSINESS ADDRESS____________________________________________________

 

 

CERTIFICATE OF ATTORNEY

 

I , __________________________ certify that, I have a license to practice law in the State of North Carolina and I meet the criteria described below.

1)                  The applicant visits the courthouse for business on a frequent basis.

2)                  N.C. State Bar Number__________________________.

3)                  What Day and Time Range will you need access into the courthouse?

________________________________________________________

________________________________________________________

 

 

Requirement at Time of Application

 

1)      Completed Application

 

I understand this I.D. badge cannot be loaned to another individual. I will not allow a person without a badge to accompany me through the card swipe entrances or carry unauthorized items into the courthouse. I further understand it is my duty to secure this badge, and agree to contact Security immediately at 318-6774 if lost or stolen. I understand this is a privilege, which can be rescinded in the sound discretion of the issuing authority.

 

Signature of Applicant_______________________________Date______________

 

COST:            1.  $15.00 PER CARD (INITIAL CARD)

2.  $25.00 FEE FOR DUPLICATE CARD IF LOST OR STOLEN.