Va. R. Sup. Ct. 1
IN THE SUPREME COURT OF VIRGINIA
REGISTRATION STATEMENT FOR LAWYER ENGAGING IN TEMPORARY
PRACTICE FOLLOWING DETERMINATION OF MAJOR DISASTER
Pursuant to Virginia Supreme Court Rule 10(f), the undersigned must complete the following and file it with the Clerk of the Supreme Court of Virginia, 100 North 9th Street, 5th Floor, Richmond, Virginia 23219 within 30 days of the commencement of the provision of legal services. The attorney's oath must be administered by a Judge or Justice of a court of record.
1. Name
Lawyer's full name.
_____________________________________________________________________________________
Name of lawyer's firm.
_____________________________________________________________________________________
2. Home State Information
Lawyer's residential address in home state. _____________________________________________________________________________________
Lawyer's business address in home state.
_____________________________________________________________________________________
Lawyer's telephone number in home state.
_____________________________________________________________________________________
Lawyer's e-mail address.
_____________________________________________________________________________________
3. Virginia Information
Lawyer's residential address in Virginia.
_____________________________________________________________________________________
Lawyer's business address in Virginia.
_____________________________________________________________________________________
Lawyer's telephone number in Virginia.
_____________________________________________________________________________________
Lawyer's email address.
_____________________________________________________________________________________
4. Bar admission
List the courts before which you have been admitted to practice, the respective periods of admission, and your registration or bar numbers.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is your license to practice currently subject to disbarment, suspension, or restrictions in any jurisdiction?
[ ] Yes [] No
If yes, explain the proceedings on a separate page and attach copies of all related documents.
5. Temporary Practice Following Determination of Major Disaster
(Check all that apply)
Specify whether you will engage in temporary practice pursuant to:
[ ] Virginia Supreme Court Rule 10(b) (pro bono legal services) ]
[ ] Virginia Supreme Court Rule 10(c) (legal services reasonably related to lawyer's practice of law in jurisdiction or area where the disaster occurred)
I agree that I am subject to the disciplinary authority of Virginia and the Virginia Rules of Professional Conduct, as set forth in Rule 8.5 ofthe Virginia Rules of Professional Conduct.
[ ] Yes [] No
ATTORNEY CERTIFICATION
I certify under penalty of perjury and pursuant to the laws ofthe Commonwealth of Virginia that the preceding is true and correct. I also certify under penalty of perjury that I have taken the required attorney oath and have attached the motion and oath documents, signed by the Judge or Justice of a court ofrecord who administered the oath.
I certify under penalty of perjury and pursuant to the laws of the Commonwealth ofVirginia that I am licensed and in good standing and authorized to practice law in each jurisdiction listed above and my license is not subject to suspension or restriction in any jurisdiction.
| ______________________________________________ | ______________________________________________ |
| Date | Signature |
Va. Sup. Ct. 1