Application For Admission To Practice (Page 3 of 5) in pdf

Application For Admission To Practice Page 3

11. Citizenship (set forth name of country)

12. If a naturalized citizen of the United States, state, date and court in which naturalization proceedings took

place.

13. Have you been suspended or disbarred from practice anywhere, or have you been censured or given any

reprimand pertaining to your conduct or fitness as a member of the Bar?

If yes, explain

Yes

in full. Use separate sheet if necessary.

14. Has your right to practice before any federal, state or municipal department, bureau, commission, office or

Yes

agency of any kind ever been qualified, terminated or withdrawn?

If yes, explain in full.

Use

separate sheet if necessary.

15. (a) Have you been a defendant in any criminal proceeding in which allegations of fraud, misrepresentation

or other dishonesty were made against you?

If yes, explain in full and attach hereto copies

Yes

of all court documents relative to the disposition of such proceedings. Use separate sheet if necessary.

(b) Have you been convicted of a criminal charge other than a motor vehicle or traffic violation for which

collateral could be forfeited?

Yes

If yes, explain in full and attach hereto copies of all court

documents relative to your charge and conviction. Use separate sheet if necessary.

allegations of fraud, misrepresentation or other dishonesty were made against you?

If yes,

Yes

explain in full and attach hereto copies of all court documents relative to the disposition of such

proceedings. Use separate sheet if necessary.

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USCA Form 81

Rev. Dec. 2016

Application For Admission To Practice Page 3