3. I engage in the private practice of law in the State of Connecticut. 3. I engage in the private practice of law in the State of Connecticut.ATTORNEY REGISTRATION CHANGE OF INFORMATION JD-GC-10 Rev. 1-19 P.B. 247247 2-27, 2-27A, 2-55 None None 2. The following is a list of all other jurisdictions (States and District of Columbia only) where I have ever been admitted to practice as a lawyer:FOR QUESTIONS, EMAIL Attorney.registration@jud.ct.gov Or call (860) 568-5157 Enter All Previously Registered Public Information Here Enter New or Corrected Public Information HereSTATE OF CONNECTICUT JUDICIAL BRANCH STATEWIDE GRIEVANCE COMMITTEE 287 Main Street, 2nd Floor, Suite 2 East Hartford, CT 06118-1885 www.jud.ct.gov/sgc 2. The following is a list of all other jurisdictions (States and District of Columbia only) where I have ever been admitted to practice as a lawyer: 4. I, individually or through the firm with which I am associated, participate in IOLTA (Interest on Lawyer's Trust Accounts) pursuant to Rule 1.15 of the Rules of Professional Conduct: 5. I do not maintain a fiduciary account. 4. I, individually or through the firm with which I am associated, participate in IOLTA (Interest on Lawyer's Trust Accounts) pursuant to Rule 1.15 of the Rules of Professional Conduct: 5. I do not maintain a fiduciary account. 1. Name of Attorney 1. Name of Attorney (Include proof of name change) Firm or business name (Primary law or business office) Firm or business name (Primary law or business office) Office address (Number and street) Office address (Number and street) Post Office box Post Office box City State Zip code City State Zip code Judicial District(s) of law office(s) (For Attorney with Connecticut addresses only) Judicial District(s) of law office(s) (For Attorney with Connecticut addresses only) Business telephone (Leave telephone number blank if at least one of the following boxes has been checked) Business telephone (Leave telephone number blank if at least one of the following boxes has been checked) I do not maintain a business telephone I do not work in the U.S. or its territories I do not maintain a business telephone I do not work in the U.S. or its territories Juris number Juris number Year State Year State Year State Year State Year State Year State Yes Not at all Pro Hac Vice (Proceed to question 7) Retired (Pursuant to P.B. section 2-55) Yes Not at all Pro Hac Vice (Proceed to question 7) Retired (Pursuant to P.B. section 2-55) Yes No Yes No ("X" here ) ("X" here ) Read the accompanying instructions before preparing this document. Questions about completing this form may be e-mailed to Attorney.Registration@jud.ct.gov OR call (860) 568-5157 6. Minimum Continuing Legal Education (MCLE) Compliance Certification a. I have complied with the MCLE requirements for the past year: b. I claim one or more of the following exemptions from the MCLE requirements: Yes No Exempt (You must answer question 6b.) I am retired pursuant to P.B. section 2-55. I served on active duty in the armed forces for more than six I was admitted to the bar this year or last year. I was certified as authorized house counsel this year or last year. I earned less than $1000 in compensation for the provision of legal I was granted a temporary or permanent exemption from themonths in the past year.services in the past year.Statewide Grievance Committee. 6. Minimum Continuing Legal Education (MCLE) Compliance Certification a. I have complied with the MCLE requirements for the past year: b. I claim one or more of the following exemptions from the MCLE requirements: Yes No Exempt (You must answer question 6b.) I am retired pursuant to P.B. section 2-55. I served on active duty in the armed forces for more than six I was admitted to the bar this year or last year. I was certified as authorized house counsel this year or last year. I earned less than $1000 in compensation for the provision of legal I was granted a temporary or permanent exemption from themonths in the past year.services in the past year.Statewide Grievance Committee. of Page American LegalNet, Inc. www.FormsWorkFlow.com JD-GC-10 Rev. 1-19 Juris number 1. Name of Attorney Enter All Previously Registered Non-Public Information Here Enter New or Corrected Non-Public Information Here 7. Home address (Number, street, city, state, zip code) 7. Home address (Number, street, city, state, zip code) Office e-mail address Date of birth (Month, day, year) Office e-mail address Date of birth (Month, day, year)Certification I certify that the information provided is true. If any statements are willfully false, I realize I am subject to discipline by the Superior Court. Attorney's signature u Date signedRetain a copy for your records and mail original to: STATEWIDE GRIEVANCE COMMITTEE, ATTORNEY REGISTRATION 2nd Floor, Suite Two 287 Main Street East Hartford, CT 06118-1885. of Page 8. I, individually or through the firm with which I am associated, maintain the following fiduciary account(s). (If no account is maintained leave blank; Associates and Of Counsel list firm information.) Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Enter New or Corrected Information Here Enter All Previously Registered Information Here Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: Corrected New City: Financial Institution: Account number: City: Financial Institution: Account number: American LegalNet, Inc. www.FormsWorkFlow.com JD-GC-10 Rev. 1-19 Instructions for Completing the Attorney Registration and Change of Information Forms Note: Except for pro hac vice attorneys and attorneys who have been granted an exclusion from electronic services requirements, attorneys and authorized house counsel must enroll in judicial branch e-services and register electronically at www.jud.ct.gov . Excluded attorneys and pro hac vice attorneys must submit the enclosed paper form. PUBLIC INFORMATION Question 1: (Name, Address, Location of Connecticut Offices and Business Telephone) If your business address or home address is different from what is listed on the form, print clearly or type the correct information on the right side of the form. If you are currently unemployed or do not have a business address, write none in the business address section on the right side of the form. NOTE: If you register your home address in the office address section of the form it will be considered public information. In the box labeled "Judicial District(s) of Law Office(s)" enter the abbreviation of the judicial district(s) in which you or your firm maintains your law office(s). See abbreviations below. Ansonia/Milford -AM New Britain -HHB New London -NL Danbury -DAN Litchfield -L Stamford/Norwalk -SN Fairfield -F Middlesex -M Tolland -T Hartford -HHD New Haven -NH Waterbury -WBY Windham -WIN Provide your business telephone number with area code. If you do not maintain a business telephone, or work outside of the United States and its territories, check the appropriate box. Question 2: (Admitted In Other Jurisdictions?) If you have been admitted to practice in other jurisdictions, write in the year and abbreviation of the state or jurisdiction on the right side of the form. Do not list U.S. federal court admissions or admission to foreign countries. The Judicial Branch database can only record information regarding admissions to 3 other jurisdictions. If you are admitted to more than 3 other jurisdictions, list additional admission information on a separate piece of paper. You do not have to list your admission to Connecticut. We already have that