Fillable Attorney Licensing Statement and Certification of Compliance with (Vermont Judiciary)

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Attorney Licensing Statement and Certification of Compliance with (Vermont Judiciary)

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900-00001 - Attorney Licensing Statement & Certification of Compliance (10/2017) Page 1 of 5
Attorney Licensing Statement
and
Certification of Compliance with the Rules for Mandatory Continuing Legal Education
I INSTRUCTIONS
This form has been prescribed by the State Court Administrator as the attorney licensing statement for
both first-time licensing and biennial license renewal. It has also been approved by the Board of
Mandatory Continuing Legal Education as the biennial report of compliance with the Rules for Mandatory
Continuing Legal Education.
An attorney who completes and submits this form acknowledges having reviewed and complied with
Administrative Order 41, Administrative Order 44, and the Rules for Mandatory Continuing Legal Education.
For Renewing Attorneys: YOU ARE REQUIRED TO COMPLETE AND FILE THIS FORM AND PAY THE REQUIRED
FEE EVERY TWO YEARS, ON OR BEFORE JULY 1 FOLLOWING THE END OF THE APPLICABLE TWO-YEAR
REPORTING PERIOD. ATTORNEYS WHO FAIL TO MEET THE JULY 1 DEADLINE ARE SUBJECT TO IMMEDIATE
SUSPENSION AND THE IMPOSITION OF AN ADDITIONAL FEE. From May 1 through July 1, you can renew
and pay online rather than submit this form, by going to https://secure.vermont.gov/courts/licensing. If
you renew online, you do not need to otherwise submit this form.
Complete this form, retain a copy, and mail to:
Office of Attorney Licensing
Costello Courthouse
32 Cherry Street, Suite 213
Burlington, VT 05401
This form must be accompanied by a check for the appropriate fee per the fee schedule approved by the
State Court Administrator. Checks should be made payable to ATTORNEY LICENSING.
If you intend to relinquish your license, do not fill out this form. Contact the Office of Attorney Licensing.
II CONTACT INFORMATION (each field is required, except that attorneys licensing for the first time should
leave the space for attorney license number blank)
1. Last name:
2. First name:
3. Attorney License Number:
4. Email address:
5. Phone:
6. Business address:
7. Residential address:
VERMONT SUPREME COURT
OFFICE OF THE STATE COURT ADMINISTRATOR
BOARD OF MANDATORY CONTINUING LEGAL EDUCATION
CHARACTER & FITNESS COMMITTEE
900-00001 - Attorney Licensing Statement & Certification of Compliance (10/2017) Page 2 of 5
III CERTIFICATION OF COMPLIANCE WITH THE RULES FOR MANDATORY CONTINUING LEGAL EDUCATION
(for renewing attorneys only)
For the two-year reporting period ending June 30 of this year:
____ I have been on ACTIVE status and thus was required to complete 20 hours of accredited continuing
legal education, with at least 2 of those hours in legal ethics and no more than 10 of those hours in
“self-study,” as defined by the Rules for Mandatory Continuing Legal Education.**
____ I satisfied the continuing legal education requirement.
____ I did not satisfy the continuing legal education requirement. I have filed, or will file within
10 days, a makeup plan with the Board of Mandatory Continuing Legal Education.
____ I did not satisfy the continuing legal education requirement but am claiming INACTIVE
status for the upcoming reporting period that begins on July 1 of this year. I understand
that I will be placed on Special Waiver status and hence will be subject to the requirements
of Section 11(c) of the Rules for Mandatory Continuing Legal Education should I at any time
seek to be reinstated to ACTIVE status.
____ I have been on PRO BONO EMERITUS status and thus was required to complete 8 hours of
accredited continuing legal education, with at least 2 of those hours in legal ethics.**
____ I satisfied the continuing legal education requirement.
____ I did not satisfy the continuing legal education requirement. I have filed, or will file within
10 days, a makeup plan with the Board of Mandatory Continuing Legal Education.
____ I have been on JUDICIAL status and thus am exempt from the continuing legal education
requirement.
____ I have been on INACTIVE status and thus am exempt from the continuing legal education
requirement.
____ I have been on INACTIVE status for at least three years immediately preceding July 1 of this year,
but I am claiming ACTIVE status for the upcoming reporting period that begins on July 1 of this
year. Within the two years immediately preceding this July 1, I completed 20 hours of accredited
continuing legal education, with at least 2 of those hours in legal ethics and no more than 10 of
those hours in “self-study,” as defined by the Rules for Mandatory Continuing Legal Education.**
____ My license is on administrative or disciplinary suspension. (Contact the Office of Attorney Licensing
for additional forms and requirements.)
**Any hours of continuing legal education that were completed pursuant to a prior makeup plan cannot be used
to satisfy other continuing legal education requirements.
900-00001 - Attorney Licensing Statement & Certification of Compliance (10/2017) Page 3 of 5
IV LICENSING STATUS (for the upcoming reporting period**)
Please indicate the licensing status that you are claiming for the upcoming reporting period**.
____ ACTIVE: An attorney on active status is authorized to practice law in the State of Vermont and must
comply with the Rules for Mandatory Continuing Legal Education.
____ INACTIVE: An attorney on inactive status is not authorized to practice law in the State of Vermont
and is exempt from compliance with the Rules for Mandatory Continuing Legal Education, except
to the extent that those rules apply to attorneys who transfer to active status.
____ JUDICIAL: An attorney who is a Supreme Court Justice, Superior Judge, Magistrate, or Judicial
Bureau Hearing Officer has judicial status and is exempt from compliance with the Rules for
Mandatory Continuing Legal Education.
____ PRO BONO EMERITUS: An attorney on pro bono emeritus status is not authorized to practice law,
except to provide legal services without fee or expectation of fee, under the auspices of a nonprofit
organization, to persons of limited means or to charitable, religious, civic, community,
governmental, and educational organizations which are designed primarily to address the needs of
persons of limited means. An attorney on pro bono emeritus status is subject to the Rules for
Mandatory Continuing Legal Education, except that the attorney must complete at least 8 hours of
accredited continuing legal education, including at least 2 hours in ethics, during each 2-year
licensing period. AN ATTORNEY CLAIMING THIS STATUS FOR THE FIRST TIME MUST ALSO SUBMIT A
COMPLETED PRO BONO EMERITUS LICENSING STATEMENT. PLEASE ALSO REVIEW SECTION 11 OF
ADMINISTRATIVE ORDER 41 FOR A FULL UNDERSTANDING OF PRO BONO EMERITUS STATUS.
For Newly Admitted Attorneys: Note that requirements of the Rules for Mandatory Continuing Legal
Education (“MCLE”) are separate and in addition to your first-year continuing legal education requirements
specified in Rules 12 and 15 (although all continuing legal education courses taken to satisfy the Rule 12
and 15 first-year CLE requirements will count toward the MCLE requirement during your first reporting
period). Also, you are subject to the Rule 12 and 15 requirements regardless of the licensing status you are
claiming.
** Upcoming Reporting Periods
For Attorneys Licensing for the First Time (except Pro Bono Emeritus attorneys): Your upcoming reporting
period begins on the date of admission and ends on June 30 of the second full year following the year of admission.
For Pro Bono Emeritus Attorneys Licensing for the First Time: Your upcoming reporting period begins on the
date you receive your licensing card and ends on June 30 of the second full year following the year of licensing.
For Renewing Attorneys: Your upcoming reporting period begins on July 1 and ends on June 30 of the
second succeeding year.
900-00001 - Attorney Licensing Statement & Certification of Compliance (10/2017) Page 4 of 5
V POOLED INTEREST BEARING TRUST ACCOUNT INFORMATION
Administrative Order 41 requires an attorney who claims ACTIVE status to provide the account number for
the attorney’s pooled interest bearing trust account (IOLTA) or to claim an exemption.
Please list each pooled interest bearing trust account. Include additional pages if necessary.
Account number:
Financial Institution:
Account number:
Financial institution:
Account number:
Financial institution:
OR
Please certify why you are not providing an account number for a pooled interest bearing trust account.
____ I am claiming ACTIVE or PRO BONO EMERITUS status, but, as defined by Rule 1.15(a)(2) of the Rules
of Professional Conduct, I do not handle or receive funds of clients or third persons “in connection
with a representation” and have no reasonable expectation of doing so during the upcoming
reporting period.
____ I am claiming INACTIVE or JUDICIAL status.
VI CERTIFICATION OF REGISTRATION OF E-MAIL ADDRESS WITH eCABINET
____ I certify that I have registered, or will register within 24 hours of receiving my license card, at least
one e-mail address with eCabinet pursuant to Administrative Order 44 and the Rules for Electronic
Filing.
OR
____ I am exempt from this registration requirement because I am claiming INACTIVE status.
VII DECLARATION REGARDING TAXES DUE TO THE STATE OF VERMONT
____ By signing and submitting this licensing statement, I declare, under the pains and penalty of
perjury, that I am in good standing with respect to any and all taxes due to the State of Vermont, as
of the date of my signature and as defined by Administrative Order 41.
VIII CERTIFICATION REGARDING CHILD SUPPORT
____ I certify that I am not under an obligation to pay child support or am in good standing with respect
to any and all child support that I am under an obligation to pay.
900-00001 - Attorney Licensing Statement & Certification of Compliance (10/2017) Page 5 of 5
IX VERMONT BAR FOUNDATION OPT-IN
The Vermont Supreme Court has authorized the attorney licensing statement to include an “opt-in” for
attorneys to donate to the Vermont Bar Foundation (“VBF”) to support legal services for the
disadvantaged. By opting in, an attorney commits to making a donation, in the amount of his or her own
choosing, to the VBF.
To make your optional donation, you can visit the VBF website at https://vtbarfoundation.org/donate/ or
mail your donation to: Vermont Bar Foundation, P.O. Box 1170, Montpelier, VT 05601-1170.
____ I opt-in to make a donation to the Vermont Bar Foundation.
X ATTESTATION AND SIGNATURE
By signing and submitting this document, I attest that the representations herein are true and that I have
not omitted any information that is reasonably responsive or related to the information requested. I also
certify that I have reviewed Administrative Order 41 and that I understand the licensing status that I have
claimed.
Dated this _________ day of ________________________, 20____.
________________________________________________
Signature of Attorney
FOR RENEWING ATTORNEYS: THE DEADLINE FOR RENEWING YOUR LICENSE IS JULY 1.
ATTORNEYS WHO FAIL TO MEET THIS DEADLINE ARE SUBJECT TO IMMEDIATE SUSPENSION
AND THE IMPOSITION OF AN ADDITIONAL FEE.
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