Affidavit In Support Of Application To Resign While Proceeding Or Investigation Is Pending - Supreme Court Of The State Of New York Page 23

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I was admitted to the New York State Bar on [date] by the ___________ Judicial

Department, and my attorney registration number is ___________.

I have also been admitted to practice in the following courts or jurisdictions:

_________________.

- OR -

I attest that I have not been admitted to practice in any other courts or jurisdictions.

I have been the subject of professional discipline in the following other courts or

jurisdictions: [state the court or jurisdiction, the date, the nature of the discipline imposed,

whether such discipline was public or private, and whether or not you have been reinstated to

practice and are now in good standing in such court or jurisdiction].

[A copy of each order or judgment imposing such discipline is attached as exhibit ____ hereto.

A copy of each order or judgment reinstating me to practice is attached as exhibit ____ hereto.]

- OR -

I attest that I have not been the subject of professional discipline in this or any other court or

jurisdiction.

I am currently the subject of an attorney disciplinary complaint or proceeding in the

following courts or jurisdictions: [state the nature of the complaint or proceeding, the

disciplinary authority before which it is pending, and the status thereof].

- OR -

I attest that I am not currently the subject of an attorney disciplinary complaint in this or any

other court or jurisdiction.

10.

Since the date of my admission to the New York State Bar, I have been arrested, charged

with, indicted, convicted, tried, and/or entered a plea of guilty to the following felonies,

misdemeanors, violations, and/or traffic infractions: [state the court, the offense charged, and

date and nature of disposition].

[Certificates of conviction pertaining to the above are attached as exhibit ___ hereto.]

- OR -

I attest that, since the date of my admission to the New York State Bar, I have not been arrested,

charged with, indicted, convicted, tried, and/or entered a plea of guilty to any felonies,

misdemeanors, violations, and/or traffic infractions.

11.

I am current in my attorney registration and in payment of attorney registration fees

pursuant to Rules of the Chief Administrator of the Courts (22 NYCRR) § 118.1 [or, if not

current, state the length of any delinquency and the amount of arrears].

12.

The specific reasons for this application to resign from the Bar of the State of New York

are as follows: ________________________________________________________________.

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