Internal Use Only STATE BAR OF NEVADA NRS 7.034 and NRS 425.520 LICENSE RENEWAL DISCLOSURE 2011 Annual Report of Existence OR Absence of Child Support Bar Number Print Member Name NRS 7.034 and NRS 425.520 require all licensed attorneys in Nevada report information regarding the existence or absence of child support obligations annually. Please select one of the following three options: I am NOT subject to a court order for the support of a child. I am subject to a court order for the support of one or more children and am in compliance with the order or am in compliance with a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order. I am subject to a court order for the support of one or more children and am not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order. Signature Date Please remit completed form to: State Bar of Nevada 600 East Charleston Blvd. Las Vegas, NV 89104 1563 American LegalNet, Inc. www.FormsWorkFlow.com