Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: F-0+ A%%(#4(2 1 2- A..

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APPLICATION FOR ADMISSION TO PRACTICE
AS AN ATTORNEY AND COUNSELOR-AT-LAW IN THE
STATE OF NEW YORK
FORMAFFIDAVIT AS TOAPPLICANTS GOOD MORAL CHARACTER
NEWYORK STATE SUPREME COURT
APPELLATE DIVISION: (select)
1
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DEpt. 2
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DEpt. 3
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DEpt. 4
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In the Matter of the Application of
(name of applicant)
for Admission to Practice as an
Attorney and Counselor-at-Law.
InstrUCtIOns
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STATE (COUNTRY) OF )
) SS.:
COUNTY (CITY) OF )
I, (name of affiant), being duly sworn,
depose and say that the answers to the following questions have been written by me or under my direction;
that the substance and the language have been supplied by me and not by applicant or any other person; and
that both the questions and the answers have been carefully read by me, and that the several answers are true
to my own knowledge, except those stated to have been made on information and belief, or which express my
opinion, and as to those answers, I believe them to be true.
1. My home and office addresses (full mailing addresses) are as follows:
Home AddRess STREET CTY / TOWN / VLLAGE
STATE ZP COUNTRY (if not USA)
TELEPHONE E-MAL (if any)
offiCe AddRess STREET CTY / TOWN / VLLAGE
STATE ZP COUNTRY (if not USA)
TELEPHONE E-MAL (if any)
BOLE ID# (NYS Board of Law Examiners dentification Number):



top seCtion only to Be Completed By AppliCAnt:
to Be Completed By AffiAnt(s) :
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: F-0+ A%%(#4(2 1 2- A..*(",271 G--# M-0* C'0"2$0
2
2. To be completed only by affiants who are attorneys. I am currently admitted to practice and in good standing
in the following jurisdiction(s) and was so admitted on the following dates:
JURSDCTON YEAR OF ADMSSON
JURSDCTON YEAR OF ADMSSON
3. In answer to this question, affiants should provide the following: (1) the length and nature of affiants acquain-
tance with applicant; (2) affiants opinion as to applicants good moral character and general fitness to practice
law; (3) the basis for affiants opinion; (4) any other information or facts which affiant believes would be help-
ful in evaluating applicants character and fitness to practice law; and (5) whether affiant recommends appli-
cant for admission to the New York State Bar.
Signature of Affiant
Date (MM / DD / YYYY)
Subscribed and sworn to or affirmed before me this
day of in the year 20 .
n-206 p3!*("
(Affix seal or stamp.)
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