ATTORNEY REVOCATION OF RETIREMENT WRITTEN NOTICE JD-GC-25 Rev. 10-17 C.G.S. 24751-81b(g); P.B. 247 2-55STATE OF CONNECTICUT SUPERIOR COURTJUDICIAL BRANCHInstructions 1.File this form if you wish to revoke a retirement granted pursuantto section 2-55 of the Practice Book. 2.Do not file this form if you owe a fee to the Client Security Fundpursuant to section 2-70 of the Practice Book or if you retired pursuant to section 2-55A of the Practice Book. 3.Complete this form and file the original with the Statewide BarCounsel, 287 Main Street, 2nd Floor, Suite 2, East Hartford,Connecticut 06118-1885, and a copy with the clerk for the judicialdistrict of Hartford, 95 Washington Street, Hartford, Connecticut06106. Keep a copy for your records.To: Statewide Bar CounselPursuant to Section 2-55 of the Practice Book, I hereby give notice that I am revoking the retirement from the practice of law in the state of Connecticut that I was granted pursuant to Practice Book Section 2-55. I understand that upon my reinstatement to the practice of law, I will be responsible for paying the Client Security Fund fee set forth in Section 2-70(a) of the Practice Book that I am now subject to the Minimum Continuing Legal Education requirements set forth in Section 2-27A of the Practice Book, and that I will continue to comply with the registration requirements set forth in Sections 2-26 and 2-27(d) of the Practice Book. Name of Attorney (First, middle, last, suffix) Connecticut Juris number Address of Attorney (Number, street, apartment number, city, state and zip code) Signed (Attorney named above) u Name of person signing at left Date signed Effective date of retirement ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. American LegalNet, Inc. www.FormsWorkFlow.com