Strike out inapplicable words in parentheses. (Original $50.00 Filing Fee) (Renewal for 20 $40.00 Fee) (Name Change No Fee) Renewal due on or before January 31 annually. APPLICATION FOR CERTIFICATE OF REGISTRATION TO ENGAGE IN THE PRACTICE OF LAW AS A (Professional Corporation) (Professional Association) (Limited Liability Company) (Registered Limited Liability Partnership) Supreme Court Certificate No. Name of Law Firm As of the date hereof, all the (shareholders) (members) (partners) of the aforesaid (professional corporation) (professional association) (limited liability company) (registered limited liability partnership), organized and existing under and by virtue of the laws of the State of Illinois or the laws of another state or jurisdiction of the United States, hereby make application for (new) (renewed) (name change) Certificate of Registration authorizing it to engage in the practice of law within the State of Illinois, and state as follows: 1. The office of the (professional corporation) (professional association) (limited liability company) (registered limited liability partnership) in the State of Illinois is located at the following street address: , City of Zip , County of , Telephone number ( ) , , Fax number (______) ________________________________, E-Mail address ___________________________________________. Check here if the address above is for a registered agent 2. It was duly formed under the laws of the State of Illinois (or the State of , the United States. ) on the day of , pursuant to the provisions of Illinois statute or a similar statute of another state or jurisdiction of 3. The names and addresses of all the (shareholders) (members) (partners) are (attach additional pages as needed): (print or type name) (address) (print or type name) (address) (print or type name) (address) (print or type name) (address) (print or type name) (address) American LegalNet, Inc. www.FormsWorkFlow.com (print or type name) (address) (print or type name) (address) (print or type name) (address) 4. It operates on a (calendar) (fiscal) year. Its fiscal year ends on the each year. day of , in 5. Each shareholder, officer, and director of the corporation (except the secretary of the corporation), each member of the association, each member (and each manager, if any) of the limited liability company, or each partner of the registered limited liability partnership is a member of the bar of each jurisdiction in which such person practices law and that no disciplinary action is pending against any of them. 6. Unless the corporation, association, limited liability company, or registered limited liability partnership maintains minimum insurance or proof of financial responsibility in accordance with Supreme Court Rule 722, the articles of incorporation or association or organization or the partnership agreement shall provide, and in any event the shareholders, members, or partners shall be deemed to agree by virtue of becoming shareholders, members, or partners, that all shareholders, members, or partners shall be jointly and severally liable for the acts, errors and omissions of the shareholders, members, or partners and other employees of the corporation, association, limited liability company, or limited liability partnership, arising out of the performance of professional services by the corporation, association, limited liability company, or limited liability partnership while they are shareholders, members, or partners. Evidence of any such minimum insurance as required by Rule 722(b)(1) or proof of financial responsibility as required by Rule 722(b)(3) shall be provided with each application for registration by means of an affidavit or verification by certification under section 1-109 of the Code of Civil Procedure of an authorized shareholder, member, or partner of the firm. Any affidavit shall be sworn to before a person who has authority under the law to administer oaths. Do not submit insurance or financial documents with this application. Please check here if an affidavit or a Section 1-109 certification is enclosed. IN WITNESS WHEREOF, I, (print or type name) , an authorized shareholder, member, or partner, have signed this Application on the day of , 20 , declaring under penalties of perjury that the statements contained herein are true. _______ _______ ___________________________________________ (Signature) (Address) Please mail your signed and completed application to: Supreme Court of Illinois Office of the Clerk Supreme Court Building 200 East Capitol Avenue Springfield, Illinois 62701-1721 American LegalNet, Inc. www.FormsWorkFlow.com