Fillable WEB SITE DOCUMENT PROVIDER ANNUAL RENEWAL OF REGISTRATION (North Carolina State Bar)

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WEB SITE DOCUMENT PROVIDER ANNUAL RENEWAL OF REGISTRATION (North Carolina State Bar)

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WEB SITE DOCUMENT PROVIDER
ANNUAL RENEWAL OF REGISTRATION
Pursuant to 27 N.C.A.C. Ch. A, Sub. E § 0505, a registered Web site document provider renew its
registration each year before June 30. The renewal fee is $50.00.
Pursuant to 27 N.C.A.C. Ch. A, Sub. E § 0507, the initial and renewal registrations will expire on June 30
each year. If a registered provider fails to pay the renewal registration fee by July 31, the secretary will
notify the provider that the registration has expired. If a provider submits a renewal registration after
its registration has expired, it will be treated as an initial registration.
Renewal of the registration does not constitute approval by the North Carolina State Bar. The operation
of the Web site must comply with all pertinent laws, including the prohibition on the unauthorized
practice of law in N.C. Gen. Stat. § 84-2.1-10. Registration does not constitute agreement or
acquiescence by the State Bar that the operation of the Web site complies with all laws including N.C.
Gen. Stat. § 84-2.1 or 2.2.
Submission of this form, either online or to the following mailing address, accompanied by payment by
check made payable to the North Carolina State Bar will satisfy the Web site provider’s registration
renewal requirement:
Secretary of the North Carolina State Bar
c/o David Johnson, Deputy Counsel
North Carolina State Bar
P.O. Box 25908
Raleigh, North Carolina 27611
Web Site Provider Registration Renewal Information
Check here if there are no changes from the initial or prior year registration. If there are any
changes, show the changes in the fields below.
Web site Name:
Web site URL:
Legal owner of Web site Domain:
Web site Domain Registrar:
Date Web site Established:
Date Current Domain Registration Expires:
Ownership of Web site
Legal Name of Web site Owner:
Owner is: Individual Corporation, LLC Other (identify)
If a corporation or other entity, jurisdiction where initially registered:
Physical Location of Owner’s Principal Place of Business
Address 1
Address 2
City:
State:
Zip:
Name of Agent for Service of Process
Address 1
Address 2
City:
State:
Zip:
Contact Information
Name of Web site contact person:
Address 1
Address 2
City:
State:
Zip:
Telephone:
Email:
Other (Attach Additional Pages if Necessary)
I have read the foregoing form. All information is true and correct to the best of my knowledge. The
Web site continues to satisfy the statutory criteria as set forth in the initial registration. The registration
renewal fee in the amount of $50.00, made payable to the North Carolina State Bar, is enclosed. I
understand that the current registration expires on June 30.
Authorized Signature
Name:
Title:
Date:
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Completed 20 July 2020

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