Instructions: DISCIPLINARY FORM A PETITION FOR REINSTATEMENT TO PRACTICE LAW PURSUANT TO RULE 5.28 A.This petition is to be filed with the Clerk of the Supreme Court of Missouri by personsseeking reinstatement to practice law under Rule 5.28.B.Petitions are continuing. Petitioners must provide new and updated responses to anyquestion at any point while the petition is pending.C.Petitions will be referred to the Chief Disciplinary Counsel for investigation. Anadditional questionnaire requiring further documentation will be provided at that time.D.Petitioners should keep a copy of the completed petition.PERSONAL INFORMATION FULL NAME: MISSOURI BAR NUMBER: CONTACT INFORMATION HOME OR OFFICE PHONE: CELL PHONE: EMAIL ADDRESS: STREET ADDRESS LINE 1: STREET ADDRESS LINE 2: P.O. BOX: CITY: STATE: ZIP/POSTAL CODE: COUNTRY: American LegalNet, Inc. www.FormsWorkFlow.com 2 THRESHOLD REQUIREMENTS FOR REINSTATEMENT UNDER RULE 5.28 (CHECK THE APPROPRIATE RESPONSE) YES NO 1. I have paid the filing fee and reinstatement fee, required by Rule 5.28,to the Clerk of the Supreme Court of Missouri. YES NO 2. The minimum time period to apply for reinstatement set forth in theorder of suspension or in Rule 5.28 for disbarment has passed. YES NO 3. I have attached copies of all suspension or disbarment orders enteredby this Court against me as EXHIBIT A. YES NO 4. I believe that the cause for my suspension or disbarment has abated. YES NO 5. I have paid restitution to all persons injured as a result of the conductthat led to my suspension or disbarment, or their claims have been discharged by operation of law, or I have notified the injured persons of my intent to file this petition at least 10 days but not more than 90 days before the date of this petition. PROOF OF COMPLIANCE WITH THIS SECTION IS ATTACHED AS EXHIBIT B. YES NO 6. I have complied with all requirements established by the order suspending my license or disbarring me and by the requirements contained in Rules 5.27 and 5.28(b)(3). YES NO 7. I have attached proof that I have passed the multistate professional N/A responsibility examination within two years of the date of this petition. PROOF OF COMPLIANCE WITH THIS SECTION IS ATTACHED AS EXHIBIT C. (Petitioners suspended solely under Rule 5.245 who have submitted their petition within six months (and have attached proof from the Department of Revenue that the cause of suspension has been resolved) and petitioners suspended solely under Rule 15.06 or Rule 6.01(f) should check: 221N/A222 per Rule 5.28(e)). YES NO 8. If I was disbarred, I have attached proof that I have passed the bar examination prescribed by Rule 8.08 within one year of the date of this petition. PROOF OF COMPLIANCE WITH THIS SECTION IS ATTACHED AS EXHIBIT D. YES NO 9. I have attached proof, provided by The Missouri Bar, that I have met N/A the continuing legal education requirements established for reinstatement petitioners in Rule 5.28(c). PROOF OF COMPLIANCE WITH THIS SECTION IS ATTACHED AS EXHIBIT E. (Petitioners suspended solely for either MCLE non-compliance or failure to pay fees should check: 221N/A222 per Rule 5.28(e)). American LegalNet, Inc. www.FormsWorkFlow.com 3 10(A). Check here if you have pleaded guilty, nolo contendere, or been convicted of any felony, whether sentence was imposed or not. If checked, list any such cases (including the case caption, court, and case number). If checked, then respond to threshold requirement 10(B). If not checked, skip to threshold requirement 11. YES NO 10(B). I have attached proof that I successfully completed any period of confinement and any subsequent period of probation or parole occurring as a result of the conviction, plea, or finding of guilt. PROOF OF COMPLIANCE WITH THIS SECTION IS ATTACHED AS EXHIBIT F. YES NO 11. I understand that I carry the burden to establish, by clear and convincing evidence, that I have good moral character and that the best interest of the public will be served by my reinstatement to practice law. YES NO 12. I understand that my petition will be referred to the Chief Disciplinary Counsel for investigation and may be referred to the Board of Law Examiners for a character and fitness investigation. I will cooperate with any investigation and will timely provide additional documentation as required by the Chief Disciplinary Counsel and the Board of Law Examiners. YES NO 13. I affirm that the above is true. STOP: IF YOU HAVE NOT COMPLETED THE PETITION OR IF YOU ANSWERED 223NO224 TO ANY OF THE ABOVE THRESHOLD REQUIREMENTS, THEN YOU ARE NOT ELIGIBLE TO BE REINSTATED AT THIS TIME. IN SUCH EVENT, THIS PETITION WILL BE SUBJECT TO DISMISSAL ON A MOTION BY THE CHIEF DISCIPLINARY COUNSEL. SIGNATURE: PRINTED NAME: DATE: American LegalNet, Inc. www.FormsWorkFlow.com