STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS CLERK'S OFFICE RHODE ISLAND SUPREME COURT Licht Judicial Complex 250 Benefit Street Providence, Rhode Island 02903 Telephone: (401) 222-3272 attorneyreginfo@courts.ri.gov ANNUAL ATTORNEY REGISTRATION SINGLE PAYMENT FORM Article IV, Rule 1(i) requires that Rhode Island attorneys submit their annual attorney registration online using the Rhode Island Supreme Court Attorney Portal but allows the manual submission of single registration fee payments for five (5) or more attorneys provided it is accompanied with this form. Law Firm Name Business Address Business Telephone Law Firm Contact Person Contact Person Email Registration payments are due by July 1. Payments submitted after July 1 shall include $125.00 late fee for each attorney. List each attorney for whom payment is being submitted, along with the attorney's Rhode Island Bar Number, and the amount being paid for each attorney's registration fee. Attorney Name Rhode Island Bar Number Amount of Payment for Attorney (Active $200.00; Inactive $50.00) Use the continuation form if needed to list each attorney for whom payment is being submitted. By signing below, I certify that the information which appears on the Attorney Portal for each attorney listed above is true and accurate. _____________________________________________________________________ Name _____________________________________________________________________ Signature This payment does not constitute payment of Rhode Island Bar Association dues. Supreme-10 (revised April 2015) American LegalNet, Inc. www.FormsWorkFlow.com Date STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS CLERK'S OFFICE RHODE ISLAND SUPREME COURT Licht Judicial Complex 250 Benefit Street Providence, Rhode Island 02903 Telephone: (401) 222-3272 attorneyreginfo@courts.ri.gov ANNUAL ATTORNEY REGISTRATION SINGLE PAYMENT FORM Continuation page if needed. Attorney Name Rhode Island Bar Number Amount of Payment for Attorney (Active $200.00; Inactive $50.00) Supreme-10 (revised April 2015) American LegalNet, Inc. www.FormsWorkFlow.com