MONTANA LAND TITLE ASSOCIATION

APPLICATION FOR ACTIVE MEMBERSHIP

The undersigned hereby makes application for ACTIVE membership in the Montana Land Title Association and certifies he/she has read the Code of Ethics and Bylaws of the organization, and agrees to comply with all provisions therein as presently stated or subsequently amended or interpreted. (Dues are based upon the latest population census report).

Note:
Article III, Sec. 1 (a) of the current MLTA Bylaws defines Active Members.
Article III, Sec. 2 of the current MLTA Bylaws defines the qualifications for election to Active Membership.

Name: ________________________________________________________________

Title Business Address: _________________________________________________

City: _________________________________________________________________                                  

County: ______________________________________________________________                      

State/Zip: _____________________________________________________________      

Phone/Fax:  ___________________________________________________________

Email: ________________________________________________________________

County for which Certificate of membership is applied for: ___________________
Note: a separate application must be submitted for each Certificate applied for.

____ Incorporated (Date of incorporation: _________
____ Sole Proprietorship
____ Partnership
____ Title insurance underwriting company
____ An agent for a title insurance underwriting company
(If so, which title insurance company: ___________________________)
____ An abstractor

If applicant is a title insurance underwriting company, does applicant have an agent that is an Active Member of the Association? ____________ (If so, attach list of ALL agents in Montana and their addresses.)

Does applicant maintain an office or title plant in the county for which Certificate of Membership is applied for? __________________

Is the title plant complete or partial? _________________

If partial, what period of time do records maintained cover? ______________________________________

Does applicant hold or has he applied for Certificates of Membership for other counties? _____________
If so,which counties?________________________________________________________________________

Give a brief description of the title records and of what they consist:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Number of employees?_____________________

List active officers, their titles, and experience in the land title business:

____________________________________________________________

____________________________________________________________

____________________________________________________________

References (Four, including ONE bank and TWO active members of the Association)

1.    Name/Company
       Business Address
       City/State/Zip

2.    Name/Company
       Business Address
       City/State/Zip

3.    Name/Company
       Business Address
       City/State/Zip

4.    Name/Company
       Business Address
       City/State/Zip

Applicant:________________________________________________

Phone/FAX #: _____________________________________________

Address: _________________________________________________

City/State/Zip: _____________________________________________

EMAIL:___________________________________________________

Signed:____________________________________    Date: _____________