Affidavit In Support Of Application To Resign While Proceeding Or Investigation Is Pending - Supreme Court Of The State Of New York Page 2

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FORM OF AFFIDAVIT
Supreme Court of the State of New York
Appellate Division:_____________ Judicial Department
________________________________________________
AFFIDAVIT IN SUPPORT OF
APPLICATION TO RESIGN
WHILE PROCEEDING OR
INVESTIGATION IS PENDING
____________________________________________________
State of ________________ )
)ss.:
County of _______________ )
____________________, being duly sworn, deposes and says that:
1.
I hereby apply, pursuant to section 1240.10 of the Uniform Rules for Attorney
Disciplinary Matters, to resign as an attorney and counselor-at-law licensed to practice in the
State of New York.
2.
My full name is ______________________. The name under which I was admitted to
the practice of law is ______________________. My name was changed on the Roll of
Attorneys and Counselors-at-Law to ______________________ by reason of (marriage, divorce
or annulment, or a court order legally changing the respondent's name). I have also been known
by the following names: ________________________________________________________.
[Copies of all court orders changing my name are attached as exhibit ___ hereto.]
3.
I was born on [date] in [city, state, country].
4.
I currently reside at [street, town or city, state, and zip code].
5.
All communications may be addressed to me at the office of my attorney, [name], at
[address], and I hereby authorize my attorney to accept and acknowledge receipt of any and all
legal documents or other notices on my behalf.
- OR -
All communications may be addressed to me personally at the following address:
_________________________.
6.
I was admitted to the New York State Bar on [date] by the ___________ Judicial
Department, and my attorney registration number is ___________.

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