900-00018 – Relinquish Vermont Law License (08/2017) Page 1 of 1
Notice of License Relinquishment
Name:
Attorney Number:
By signing and submitting this form, I understand that I am relinquishing my Vermont law license.
I certify that I am eligible to do so pursuant to Section 12 of Supreme Court Administrative Order 41. More
specifically, I acknowledge and certify:
• I am not currently the subject of any criminal or disciplinary investigations or proceedings in any
jurisdiction; and,
• I am not currently suspended or disbarred; and,
• I have provided notice of my decision to relinquish my law license to all clients by whom I have been
retained, or to whom I have provided legal services, within the 2 years immediately preceding the
submission of this form; and,
• I have fully complied with Rule 1.16 of the Vermont Rules of Professional Conduct; and,
• Once this form is accepted, I will no longer be licensed or eligible to practice law in the State of Vermont;
and,
• Once this form is accepted, I will no longer be admitted to the Bar of the Vermont Supreme Court; and,
• To regain admission, I must apply for admission to the Bar of the Vermont Supreme Court and may be
required to pass the Uniform Bar Exam; and,
• I am subject to the disciplinary jurisdiction of the Vermont Supreme Court and the Professional
Responsibility Board for conduct that occurred on or before the date that this form is accepted; and,
• Upon relinquishing my Vermont law license, if contacted, the Office of Attorney Licensing will indicate that I
relinquished my license while in good standing.
I am relinquishing my Vermont law license freely, voluntarily, and with a full understanding of Section 12 of
Supreme Court Administrative Order 41.
Submitted by: _______________________________ __________________
Signature Date
For Office Use Only:
Approved by: _____________________
Date: _____________________
