IOWA SUPREME COURT COMMISSION ON CONTINUING LEGAL EDUCATION JUDICIAL BRANCH BUILDING, 1111 EAST COURT AVENUE, DES MOINES, IOWA 50319 (515) 725-8029 Application for Extension of Time to Complete Eligibility Requirements Concerning Description or Indication of Limitation of Practice (Please type or print) Name: ____________________________________________________________________________________ Address: __________________________________________________________________________________ Zip: __________________________ E-Mail Address: __________________________________ (E-Mail is the preferred method of notifying you regarding your extension request.) Telephone No.: ( ) Social Security No.: _ Year of Admission to Practice in Iowa: _____________________________ I hereby make application pursuant to Rule 41.9 for an extension of time to complete the hours of accredited continuing legal education during the preceding calendar year as required by Iowa Rule of Professional Conduct 32:7.4. (Describe specifically and enclose additional sheets or supporting information if appropriate) Hardship or Extenuating Circumstance(s): Relief Sought: I hereby certify that the facts set forth above are true and correct and that this application is made in good faith. Dated this 12/8/05 day of , 20 . ____________________________________ Signature American LegalNet, Inc. www.USCourtForms.com