Affidavit In Support Of Application To Resign While Proceeding Or Investigation Is Pending - Supreme Court Of The State Of New York Page 6

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FORM OF AFFIDAVIT
Supreme Court of the State of New York
Appellate Division:_____________ Judicial Department
________________________________________________
AFFIDAVIT OF COMPLIANCE
FOR DISBARRED OR
SUSPENDED ATTORNEYS
____________________________________________________
State of ________________ )
)ss.:
County of _______________ )
____________________, being duly sworn, deposes and says that:
1.
I submit this affidavit pursuant to section 1240.15 (f) of the Uniform Rules for Attorney
Disciplinary Matters.
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.
The telephone numbers at which I can be contacted are:
Home _________________________
Work _________________________
Mobile _________________________.
6.
The email address at which I can be contacted is ______________________.

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