IOWA SUPREME COURT COMMISSION ON CONTINUING LEGAL EDUCATION JUDICIAL BRANCH BUILDING 1111 EAST COURT AVENUE DES MOINES, IOWA 50319 (515) 725-8029 APPLICATION FOR CERTIFICATE OF EXEMPTION (Please Type or Print) NAME: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NUMBER: YEAR OF ADMISSION TO PRACTICE IN IOWA: I hereby request to be granted a Certificate of Exemption from the requirements of Iowa Court Rule 41. I do not practice law in the State of Iowa. I fit one or more of the following descriptions: A. I work solely at a job where my Iowa license is not a requirement to hold my position with my employer named: B. I am licensed in another state and do not practice in Iowa. Name of state or states: C. I am fully retired from the practice of law in all states. PLEASE COMPLETE BOTH SIDES OF THIS FORM American LegalNet, Inc. www.FormsWorkFlow.com I understand that once granted a Certificate of Exemption, I will be in violation of chapter 41 of the Iowa Court Rules if I engage in the practice of law within the State of Iowa without first having been reinstated pursuant to Iowa Court Rule 42.7. I understand the term "practice of law" includes the examination of abstracts, consummation of real estate transactions, preparation of legal briefs, deeds, buy and sell agreements, contracts, wills and tax returns as well as the representation of others in any Iowa courts, the right to represent others in any Iowa courts, or to regularly prepare legal instruments, secure legal rights, advise others as to their legal rights or the effect of contemplated actions upon their legal rights, or to hold oneself out to so do; or to be one who instructs others in legal rights; or to be a judge or one who rules upon the legal rights of others unless neither the state nor federal law requires the person so judging or ruling to hold a license to practice law. I certify that I will not engage in the practice of law, as defined above, without first having been reinstated. I further certify that I understand the requirements for reinstatement as set forth in Iowa Court Rule 42.7. Dated this day of , 20 . Signature Return Completed application to: Commission on Continuing Legal Education Judicial Branch Building 1111 East Court Avenue Des Moines, Iowa 50319 07/11/2014 American LegalNet, Inc. www.FormsWorkFlow.com