THE STATE BAR OF NEVADA Member Services Department 3100 W. Charleston Blvd., Ste. 100 Las Vegas, NV 89102 (702) 382 - 2200 memberservices @nvbar.org Voluntary Request for SCR 98. 6 Transfer to Ina ctive Status Inactive Fee , $125 , And Disclosures Are Due Annually January 1 st . T his form is not will not be used to change your contact information. Bar No.: Member Name : Phone Number: E - mail : SCR 79 Address City State Zip I request that I be tr ansferred 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 effe ctive upon receipt of this form if an effective date is not provi ded. While on Inactive status, you are still required to submit license fees and annual disclosure s. Going Inactive after January 1 st & have not practiced law : submit original request for m, affidavit and $125 before March 1 st to avoid a late fee. Going Inactive after January 1 st & have practiced law in the same calendar year : submit original request form and full act ive lice nse fee before March 1 st to avoid a late fee. Going Inactive after March 1 st : submit original request form and full active license fee plus the late fee if dues have not already been paid. As an inactive member , you are required to maintain SC R 79 conta ct information , submit annual fees a n d disclosures. Dated this day of , 20 SIGNATURE: Contact the Nevada Bo ard of CLE to ensure compliance, 775 - 329 - 4443. Affidavit is not required if submitted & e ffective prior to the year in which you are requesting inactive status. If your mailing address is also changing, please use our change of address form . C onta ct Member Services Department at 702 - 382 - 2200 or by email at memberservices @nvbar.org with any questions. FOR SBN USE American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT I , under penalty Print Name of perjury, being fi rst duly sworn, depose and say as follows: That I have not practiced Law in the State of Nevada in the year 20 . (Fill in the calendar year of your effective date). Member Signature Dated this day of , 20 . SUBSCRIBED AND SWORN to Before me this day of , 20 . NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkFlow.com