APPENDIX DApplication for Reinstatement to the Bar After Suspension for Six Months or Less INSTRUCTIONSAn application pursuant to section 1240.16 (d) of these Rules for reinstatement to the bar aftersuspension from practice for six months or less shall comply with the following requirements: (1)The application shall be made in the form of a motion.(2)The moving papers shall bear the caption and the docket number, if any, of the proceedingresulting in the respondent's suspension.(3)The motion shall be made on notice to the Committee that was the petitioner in theproceeding leading to the respondent's suspension and to the Lawyers' Fund for Client Protection.(4)The motion shall be made, noticed, and filed in accordance with the rules of practice of theCourt. Payment of the fee required by CPLR 8022 (b) shall accompany the filing of the motionpapers, unless the movant is exempt from payment thereof pursuant to CPLR 1102.(5)The motion shall be supported by the affidavit of the respondent, subscribed and sworn tobefore a notary public or other person authorized to administer an oath.(6)The supporting affidavit shall be worded and numbered as set forth below.(7)In completing the supporting affidavit, the respondent should not omit inapplicable passages.(8)The application may be supplemented by the affidavits or affirmations of counseland character witnesses, and with additional appropriate exhibits.(9)Place the moving papers in the following order:a.The notice of motion;b.The respondent's form affidavit;c.The exhibits supporting that form affidavit;d.Any additional supporting affidavits or affirmations and exhibits thereto; ande.Affidavits reflecting service of the moving papers upon the Chief Attorney of theappropriate Committee and the Lawyers' Fund for Client Protection. American LegalNet, Inc. www.FormsWorkFlow.com FORM OF AFFIDAVITSupreme Court of the State of New YorkAppellate Division: Judicial Department AFFIDAVIT IN SUPPORT OF APPLICATION FOR REINSTATEMENT TO THEBAR AFTER SUSPENSION FOR SIX MONTHS OR LESSState of ) )ss.: County of ), being duly sworn, deposes and says that: I hereby apply, pursuant to section 1240.16 (d) of the Uniform Rules for AttorneyDisciplinary Matters, for reinstatement as an attorney and counselor-at-law licensed to practice inthe State of New York.My full name is . The name under which I was admitted tothe practice of law is . My name was changed on the Roll ofAttorneys and Counselors-at-Law to by reason of (marriage, divorceor annulment, or a court order legally changing the respondent's name). I have also been knownby the following names: .[Copies of all court orders changing my name are attached as exhibit hereto.]I was born on [date] in [city, state, country].I currently reside at [street, town or city, state, and zip code].The telephone numbers at which I can be contacted are:Home Work Mobile .The email address at which I can be contacted is .All communications may be addressed to me at the office of my attorney, [name], at[address], and I hereby authorize my attorney to accept and acknowledge receipt of any and alllegal documents or other notices on my behalf. -OR - American LegalNet, Inc. www.FormsWorkFlow.com All communications may be addressed to me personally at the following address:. 8.I was admitted to the New York State Bar on Department, and my attorney registration number is . 9.By order of this Court entered, I was suspended for months from the of law. A copy of the order imposing the suspension is attached as exhibit hereto.10.Since the entry of the order of suspension, I have also been the subject of professionaldiscipline in the following other courts or jurisdictions: [state the court or jurisdiction, the date,the nature of the discipline imposed, whether such discipline was public or private, and whetheror not you have been reinstated to practice and are now in good standing in such court orjurisdiction].[A copy of each order or judgment imposing such discipline is attached as exhibit hereto.A copy of each order or judgment reinstating me to practice is attached as exhibit hereto.]-OR -I attest that, since the entry of the order of suspension, I have not been the subject of professionaldiscipline in this or any other court or jurisdiction. Since the entry of the order of suspension, I have engaged in the following employment orhave been engaged in the following businesses: [in chronological order, state the dates soengaged, the name and address of the employer or business and the nature of each employment orbusiness].I have fully complied with the requirements of the order of suspension, including payingany required fees and costs, and I am in compliance with section 1240.15 of the Uniform Rulesfor Attorney Disciplinary Matters.Pursuant to section 1240.15 (f) of the Uniform Rules for Attorney Disciplinary Matters, Ifiled an affidavit of compliance on .[A copy of that affidavit of compliance is attached as exhibit hereto.] -OR -[I failed to file an affidavit of compliance as required by section 1240.15 (f) of the Uniform Rulesfor Attorney Disciplinary Matters for the following reason(s):]14.Since the entry of the order of suspension, I have been arrested, charged with, indicted,convicted, tried, and/or entered a plea of guilty to the following felonies, misdemeanors,violations, and/or traffic infractions: [state the court, the offense charged, and date and nature ofdisposition].[Certificates of conviction pertaining to the above are attached as exhibit hereto.]-OR -I attest that, since the entry of the order of suspension, I have not been arrested, charged with,indicted, convicted, tried, and/or entered a plea of guilty to any felonies, misdemeanors,violations, and/or traffic infractions. American LegalNet, Inc. www.FormsWorkFlow.com 15.The following facts, not heretofore disclosed to this Court, are relevant to this applicationand might tend to influence the Court to look less favorably upon reinstating me to the practice oflaw:16.I understand that the Court and the Committee may take such investigative steps as aredeemed appropriate to evaluate my character and fitness for reinstatement to the Bar. I will fullycooperate with any request for additional information and make myself available to answerquestions under oath or affirmation, as required.WHEREFORE, I request that the Court grant this application for my reinstatement as anattorney and counselor-at-law licensed to practice in the State of New York. Dated: [city or town, state] , 20 Subscribed to and sworn to before me this day of , 20 Notary Public American LegalNet, Inc. www.FormsWorkFlow.com