Rule 13.9 Compliance Declaration

A compliance declaration filed under BR 8.3 shall be in substantially the following form: COMPLIANCE DECLARATION In re: Application of (Name of attorney) (Bar number) For reinstatement as an active/inactive (circle one) licensee. 1. Full name ________________ Date of Birth ___________ 2. Residence address _________Telephone _____________ 3. I hereby attest that during my period of suspension from the practice of law from ___________to_________, (insert dates) I did not at any time engage in the practice of law except where authorized to do so. 4. I also hereby attest that I complied as directed with the following terms of probation: (circle applicable items) a. abstinence from consumption of alcohol and mind-altering chemicals/drugs, except as prescribed by a physician b. attendance at Alcoholics Anonymous meetings c. cooperation with Chemical Dependency Program d. cooperation with State Lawyers Assistance Committee e. psychiatric/psychological counseling f. passed Multi-State Professional Responsibility exam g. attended law office management counseling and/or programs h. other - (please specify) i. none required I HEREBY DECLARE THAT THE ABOVE STATEMENT IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I UNDERSTAND IT IS MADE FOR USE AS EVIDENCE IN COURT AND IS SUBJECT TO PENALTY FOR PERJURY. (Name)