Annual Limited Liability Entity Registration Statement {Supreme-14}

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPREME COURT In-House Counsel Registration I, ___________________________________, request to be registered as in-house counsel for ______________________________, a corporation/entity with an office in Rhode Island, pursuant to Rhode Island Supreme Court Rules, Article II, Rule 9(b). Rhode Island address of corporation/entity: __________________________________ __________________________________ Rhode Island telephone number __________________________________ 1. I am an employee of the above business entity (attach affidavit of employment, stating title/position). 2. The above corporation/entity is in good standing with the State of Rhode Island (attach affidavit of good standing by officer of corporation/entity). 3. I am a member in good standing of the bar(s) of the State(s) of _______________________, without any restriction on my eligibility to practice (attach certificate of good standing). I understand my obligation to notify this Court immediately of any change respecting my status in this respect. 4. I acknowledge that I am subject to the terms of Article II, Rule 9(b), of the Rhode Island Supreme Court Rules. As such, I understand that I am subject to Article III (Disciplinary Procedures), Article IV (Periodic Registration of Attorneys and Mandatory Continuing Legal Education Regulations), and Article V (Rules of Professional Conduct). 5. I understand that, as a registered in-house counsel, I am permitted to practice law in Rhode Island but only on behalf of the corporation/entity for which I am employed, its directors, officers, and employees in their respective official or employment capacities, and/or its commonly owned or controlled organizational affiliates. I understand that I shall not appear in the courts of Rhode Island or in any agency or municipal proceeding American LegalNet, Inc. www.FormsWorkFlow.com that I have reason to believe prior to the proceeding is contested, unless I am admitted pro hac vice pursuant to Article II, Rule 9(a) of the Rhode Island Supreme Court Rules. __________________________ Signature __________________________ Print name ___________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com