Government of the District of Columbia Department of Motor Vehicles Adjudication Services Administration P.O. Box 91980 Washington, D.C. 20090 WRITTEN APPEARANCE BY COUNSEL AND CONSENT BY CLIENT APPEARANCE BY COUNSEL As required by Sections 1025.5 and 1025.6 of Title 18, DCMR, I hereby enter my written appearance on behalf of ________________________________________________________, concerning Infraction Number(s) _________________________________________________. I certify that I am licensed to practice in ___________________________ and am in good standing with the highest court of that jurisdiction. Date:________________ ____________________________________ Bar Number ____________________________________ Attorney Name ____________________________________ Attorney Signature ____________________________________ Address ____________________________________ City, State, Zip code ____________________________________ Telephone Number CLIENT CONSENT* I hereby consent to the above representation and further consent that the Department of Motor Vehicles may provide my attorney with personal information about me, including my address and driving record. Date:________________ ____________________________________ Client Signature ____________________________________ Client Name *In lieu of the Client Consent section, an attorney may provide another document, signed by the client, authorizing the attorney to represent the client for the infractions listed on the consent form and to receive personal information about the client. DMV-AD-WABC-001 Rev. 12/04/07 American LegalNet, Inc. www.FormsWorkFlow.com