Affidavit In Support Of Application For Reinstatement (Disbarment Over 6 Months) {Appendix C}

APPENDIX CApplication for Reinstatement to the Bar After Disbarment or Suspension for More Than Six Months INSTRUCTIONSAn application pursuant to section 1240.16 (a) and (b) of these Rules for reinstatement to the barafter disbarment or suspension from practice for more than six months shall comply with thefollowing requirements: (1)The application shall be made in the form of a motion.(2)The moving papers shall bear the caption and the docket number, if any, of the proceedingresulting in the respondent's disbarment or suspension.(3)The motion shall be made on notice to the Committee that was the petitioner in theproceeding leading to the respondent's disbarment or suspension and to the Lawyers' Fund forClient Protection.(4)The motion shall be made, noticed, and filed in accordance with the rules of practice of theCourt. Payment of the fee required by CPLR 8022 (b) shall accompany the filing of the motionpapers, unless the movant is exempt from payment thereof pursuant to CPLR 1102.(5)The motion shall be supported by the affidavit of the respondent, subscribed and sworn tobefore a notary public or other person authorized to administer an oath.(6)The supporting affidavit shall be worded and numbered as set forth below.(7)In completing the supporting affidavit, the respondent should not omit any passages.(8)The application may be supplemented by the affidavits or affirmations of counseland character witnesses, and with additional appropriate exhibits.(9)Place the moving papers in the following order:a.The notice of motion;b.The respondent's form affidavit;c.The exhibits supporting that form affidavit;d.Any additional supporting affidavits or affirmations and exhibits thereto; ande.Affidavits reflecting service of the moving papers upon the Chief Attorney of theappropriate Committee and the Lawyers' Fund for Client Protection. American LegalNet, Inc. www.FormsWorkFlow.com FORM OF AFFIDAVITSupreme Court of the State of New YorkAppellate Division: Judicial DepartmentAFFIDAVIT IN SUPPORT OF APPLICATION FOR REINSTATEMENT TO THE BAR AFTER DISBARMENT OR SUSPENSION FOR MORE THAN SIX MONTHSState of ) )ss.: County of ), being duly sworn, deposes and says that: I hereby apply, pursuant to section 1240.16 (a) and (b) of the Uniform Rules for AttorneyDisciplinary Matters, for reinstatement as an attorney and counselor-at-law licensed to practice inthe State of New York.My full name is . The name under which I was admitted tothe practice of law is . My name was changed on the Roll ofAttorneys and Counselors-at-Law to by reason of (marriage, divorceor annulment, or a court order legally changing the respondent's name). I have also been knownby the following names: .[Copies of all court orders changing my name are attached as exhibit hereto.]I was born on [date] in [city, state, country].I currently reside at [street, town or city, state, and zip code].The telephone numbers at which I can be contacted are:Home Work Mobile .The email address at which I can be contacted is .All communications may be addressed to me at the office of my attorney, [name], American LegalNet, Inc. www.FormsWorkFlow.com [address], and I hereby authorize my attorney to accept and acknowledge receipt of any and alllegal documents or other notices on my behalf. -OR -All communications may be addressed to me personally at the following address:. 8.I was admitted to the New York State Bar on Department, and my attorney registration number is .9.By order of this Court entered ,I was [suspended for years -or- months -or- disbarred] from the practice of law. My use of the term "discipline" hereinafter refers to thesanction imposed by this Court in the foregoing order. A copy of the order imposing discipline isattached as exhibit hereto.10.Other than the location specified in paragraph 4 hereof, I have resided at the followingaddresses since the entry of the order of discipline: [in chronological order state the approximatedates of residence, street, town or city, state, and zip code].-OR -I attest that I have resided continually at the location specified in paragraph 4 hereof since theentry of the order of discipline. 11.The discipline imposed upon me was predicated upon, or arose out of, mymisappropriation or misuse of the real or personal property of others, or the failure to return legalfees received but unearned by me. I have made full restitution to the owners of the property ortheclients in question, and if any part of a loss occasioned by my conduct was the subject of anaward by the Lawyers' Fund for Client Protection pursuant to Part 7200 of this Title, I have madefull restitution to the Fund, except as follows:[A statement listing each property, its dollar value, the name of the true owner, and the extent towhich I have made or have yet to make restitution is attached as exhibit hereto.]-OR -I attest that the discipline imposed upon me was not predicated upon, and did not arise out of,charges that I willfully misappropriated or misapplied money or property in the practice of law.12.On the date the order of discipline was entered, the following matters, which were not thebasis of this Court's order, were pending against me before any attorney grievance committee inthe State of New York: [state the nature of the complaint, the disciplinary authority before whichit was pending, and the disposition thereof].-OR -I attest that, on the date the order of discipline was entered, no additional matters were pendingagainst me before any attorney grievance committee in the State of New York13.I have also been admitted to practice in the following courts or jurisdictions:.[Certificates of Good Standing, issued within the 30 days preceding the execution of thisaffidavitby all such courts or jurisdictions in which I am currently admitted to practice, except American LegalNet, Inc. www.FormsWorkFlow.com those in which I have not been reinstated as set forth in paragraph 14 hereof, are attached asexhibit hereto.]-OR -I attest that I have not been admitted to practice in any other courts or jurisdictions.14.From the date of my admission to the New York State Bar until the present, I have alsobeen the subject of professional discipline in this or any other court or jurisdiction: [state thecourt or jurisdiction, the date, the nature of the discipline imposed, whether such discipline waspublic or private, and whether or not you have been reinstated to practice and are now in goodstanding 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, with the exception of the discipline imposed by this Court from which I now seekreinstatement, from the date of my admission to the New York State Bar until the present I havenot been the subject of professional discipline in this or any other court or jurisdiction. 15.Since the entry of the order of discipline, I have complied with the terms of the order inall respects and have not (1) engaged in the practice of law in any form in the State of New York,either as principal or agent, or a clerk or employee of another, (2) accepted any new retainer orotherwise agreed to represent any legal client in New York , or (3) solicited or procured, eitherdirectly or indirectly, legal business for any attorney in New York.-OR -Since the entry of the order of discipline, I have engaged in the practice of law in the State ofNew York in the following manner: [in chronological order, state the nature, date and duration ofany legal work performed in New York since the effective date of discipline, including anyappearances before any court or tribunal as an attorney for another, and the preparation of anylegal instrument or document.]16.Since the entry of the order of discipline, I have engaged in the practice of law in thefollowing other courts or jurisdictions and in the following manner:-OR -I attest that, since the entry of the order of discipline, I have not engaged in the practice of law inany other courts or jurisdictions. Since the entry of the order of discipline, I have engaged in the following e