IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO APPLICATION FOR READMISSION OR REINSTATEMENT TO THE BAR OF THE COURT PURSUANT TO D.C.COLO.LAttyR 11 - REINSTATEMENT AND READMISSION Pursuant to D.C.COLO.LAttyR 3, admission to the bar of this court is limited to those who are in good standing in all courts and jurisdictions where admitted. Pursuant to D.C.COLO.LAttyR 11, an attorney who is not in good standing due to suspension or disbarment may apply for reinstatement or readmission utilizing the following form. 1. Name on File: (M ) (F ) 2. Other Names Used: 3. Firm Name: 4. Firm Address: City: State: Zip: 5. Office Telephone: 6. E-mail Address: 7. Date First Admitted to This Court: 8. Colorado Bar Number (if applicable): 9. Date Suspended or Disbarred: 10. Give full explanation of the discipline that led to the suspension or disbarment. Use a separate sheet if necessary. Attach documentation. 11. Were you reciprocally disciplined by any jurisdiction? Yes No If yes, give full explanation, including the name, address and telephone number of each disciplining jurisdiction(s), the date and type of discipline, and your current standing in each jurisdiction that disciplined you (e.g., reinstated with or without conditions; still Revised 12.2016 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com under suspension or disbarment, etc.). Use separate sheet if necessary. Attach documentation. 12. Other than the discipline (if any) described in Item No. 11, have you received any discipline (including disbarment, suspension, censure or reprimand) in any jurisdiction since you were suspended or disbarred by this court? Yes No If yes, indicate the jurisdiction (including address and telephone), date and nature of the discipline, and reason for the discipline. Use a separate sheet if necessary. Attach documentation. 13. Pursuant to D.C.COLO.LAttyR 11, reinstatement or readmission is neither automatic nor a matter of right. Explain why the court should grant your application for reinstatement or readmission. Use a separate sheet if necessary. 14. I consent to this court's exercise of disciplinary jurisdiction over me in connection with this application and any alleged misconduct related to my admission to and practice before the bar of this court. Yes No Revised 12.2016 Page 2 American LegalNet, Inc. www.FormsWorkFlow.com 15. I certify that I have read and am familiar with the local rules of this court and that I will comply with all of the provisions thereof. Yes No 16. I recognize that, if readmitted to the bar of this court, I am duty bound to give immediate written notice to the clerk of the court of any formal discipline imposed upon me, including dates and terms thereof, by any court or attorney licensing agency. Yes No 17. I solemnly swear (or affirm) that as an attorney and counselor of this court, I will conduct myself in a professional and ethical manner at all times, and I will support and defend the Constitution of the United States. Yes No DECLARATION UNDER PENALTY OF PERJURY I declare under penalty of perjury that the information in this motion and affidavit is true and correct. See 28 U.S.C. 247 1746; 18 U.S.C. 247 1621. Signature: Date: Submit original and one copy, and Jeffrey P. Colwell, Clerk a check payable to 223Clerk of the Attn: Secretary for Committee on Conduct Court224 for $216.00 (non-refundable): United States District Court Alfred A. Arraj U.S. Courthouse, Room A-105 901 19th Street Denver, Colorado 80294-3589 Phone (303) 844-3433 Revised 12.2016 Page 3 American LegalNet, Inc. www.FormsWorkFlow.com