FLORIDA BAR ETHICS OPINION REQUEST FORM Name: ___________________________________________ Florida Bar Number: ______________________ Address: _____________________________________________Phone No.: ___________________________ Concise Summary of Relevant Facts: List your ethical concerns and the specific question(s) presented: List relevant ethics rules or opinions: List relevant case law: Yes Yes Yes No No No Is there a past or pending bar complaint related to this matter? Is the matter pending before any court or tribunal? Did you speak to anyone at The Florida Bar regarding this matter? If yes, on what date? ___________ Who did you speak with and what was discussed? Please attach any pertinent documentation or additional information. Check here if additional sheet is attached. I HEREBY STATE that the above request is true and relates to my own future conduct. ___________________________________________ Signature ________________________________________ Date Send Request To: Ethics Department, The Florida Bar, 651 E. Jefferson Street, Tallahassee, Florida 32399-2300 Please allow three to five weeks for a written response. American LegalNet, Inc. www.FormsWorkFlow.com