Notice Of Reciprocity

COMMONWEALTH OF PENNSYLVANIA GOVERNOR'S OFFICE PENNSYLVANIA HUMAN RELATIONS COMMISSION In the matter of: Case No.: Appearing on Behalf of: NOTICE OF RECIPROCITY I hereby certify that I am an attorney at law admitted to practice before the highest court of _____________________________, as evidenced by the attached copy of my current (name of jurisdiction) license to practice before such court (a card or similar credential evidencing the current ability to practice before such court shall suffice). The above-named jurisdiction has a civil rights agency, similar in jurisdiction and function to the Pennsylvania Human Relations Commission, which allows members of the bar of Pennsylvania the reciprocal right to practice before such agency. Said agency is the _____________________________________________________. (name of similar civil rights agency) ____________________________________ Signature ____________________________________ Name (Printed) ____________________________________ P.O. Address ____________________________________ City, State, and Zip Code ____________________________________ Telephone (including area code) ____________________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com