FOR OFFICIAL USE ONLY THE STATE BAR OF NEVADA Member Services Department P.O. Box 50 Las Vegas, NV 89125-0050 (702) 317-1430 suzannew@nvbar.org RCVD$: Voluntary Request for SCR 98.6 Transfer to Inactive Status Bar No.: Member Name: Phone Number: ___________________ E-mail: I hereby request that I be transferred to Inactive status with the State Bar of Nevada, effective . I am currently an active member in good standing. I understand that while on inactive status, I am not entitled to practice law in the State of Nevada in accordance with SCR 98(4). Status change will be effective upon receipt of this form. While on Inactive status, you are still required to complete the annual mandatory reporting disclosure forms. NOTE: Going Inactive after January 1st & have not practiced law submit original request form, affidavit and $125 before March 1st to avoid a late fee. Going Inactive after January 1st & have practiced law submit original request form and full bar dues before March 1st to avoid a late fee. Going Inactive after March 1st submit original request form and full bar dues plus the late fee if dues have not already been paid. Dated this SIGNATURE: day of , 20 NOTE: Affidavit is not required if submitted prior to the year in which you are requesting inactive status. If your mailing address is also changing, please make changes online at www.nvbar.org, click Member Login at the top right. Username and password information are available at login page. Any questions regarding this form please contact Suzanne in the Member Services Department at 702-317-1430 or by email at suzannew@nvbar.org. American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT I Print Name of perjury, being first duly sworn, deposes and says as follows: That I have not practiced Law in the State of Nevada in the year 2013. , under penalty Signature Dated this day of , 20 . SUBSCRIBED AND SWORN to Before me this day of , 20 . NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkFlow.com