COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Petition for Removal of CLER Delinquency : : Plaintiff(s) PLEASE TYPE OR PRINT LEGIBLY -against- : ATTORNEY # _______________________ : Index No. ADMINISTRATIVE FEE Calendar No. TOTAL PAID Send to: The Florida Bar Legal Specialization & Education 651 E. Jefferson St. Tallahassee, Florida 32399-2300 (850) 561-5842 $150.00 $______ JUDICIAL SUBPOENA : I, ____________________________ , hereby petition the Executive Director of The Florida Bar for removal of the CLER Delinquency on my membership record in The Florida Bar and certify: Defendant(s) : ...................................................... 1. I am not delinquent in payment of my annual membership fees. 2. I did not comply with my previous CLER reporting periods beginning _________ and ending __________ . (IfTHE PEOPLE OF THE STATE OF NEW YORK delinquent for more than one period, list all applicable periods.) 3. I am now in compliance with my continuing legal education requirement, Rule 6-10, by virtue of the TO following: (Please check one) ___ I have completed 30 general hours with 5 hours in ethics, professionalism, substance abuse or mental illness awareness. (Please attach all CLE course information.) ___ I have completed more than 30 hours for all of the past reporting periods listed above. (Please attach all GREETINGS: CLE course information covering all periods.) ___ I wish WEbe reinstated based that the business and excuses being laid aside, you and each of youperiod(s) to COMMAND YOU, on all following applicable exemption covering the reporting attend before listedHonorable indicated by Rule 6-10.3(c). ___________________________________ above as , the at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 4. I did not comply with CLER because: 5. During my delinquency, I have/have not (circle one) engaged in the delivery of legal services within the State of Florida failure togiven advice or rendered services on matters or issues involving or determined liable to Your or have comply with this subpoena is punishable as a contempt of court and will make you by Florida procedural orbehalf this subpoena wasfor a fee orapro bono. penalty of $50 and all damages sustained as a the party on whose substantive law, either issued for maximum result of your failure to comply. Witness, Honorable Court in County, 6. My current mailing address and telephone number are: day of , one of the Justices of the , 20 (Attorney must sign above and type name below) _______________________________________________ Signature of Petitioner COUNTY OF ________________________________________ _______________________________________________ Petitioner (Namefor Attorney(s) Typed, Printed or Stamped) On this date _________________ , Before me, the undersigned authority, this day personally appeared ______________ , who is personally known to me or has produced ___________________________________________ as identification, Office and P.O. Address who first being duly sworn says, that he or she is the petitioner in the above matter and the facts and matters set forth are true and correct. Send to: The Florida Bar Legal Specialization & Education 651 E. Jefferson St. Tallahassee, FL 32399-2300 Telephone No.: ________________________________________ Notary Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com h:/BarDepts/CLER-BLSE/FormsforCLER/cler2001.p65/pg.10 STATE _____________________________________________