NorthCarolinaStateBarREPORTDATE: ______________20______
QuarterlyReviewReportAccountName:______________________
Rule1.15‐3(i)RandomTransactionReviewAccount#: ______________________
GENERALINFORMATION
Completeoneformforeachgeneraltrustaccount, dedicatedtrustaccount,andfiduciaryaccount
Attachthefollowingforeachtransaction:statementofcostsandreceipts,clientledger,cancelledchecksor
imagesthereof,anyother
documentationnecessarytocompletereview,andanyrequiredexplanations
AtleastthreetransactionsshallsatisfytherequirementinRule1.15‐3(i),butalargersamplemaybeadvisable
Transaction#1
1.ClientName/Matter:______________/________________DateRangeofDisbursement(s)__________:__________
2.Doesclientledgershowanegativebalance? □Yes□
No Ifyes,attachexplanationandcorrectiveaction.
3.Lawyerreviewedthefollowing: StatementofCostsandReceipts □Yes □No
(AttachtoReport)ClientLedger□Yes □No
CancelledChecks(orimagesthereof)□Yes□No
Other_________________________□Yes□No
4.Didthetransactioninvolvemultipledisbursements? □Yes □No Numberof
disbursements_________________
5.Areanydisbursementsoutstanding?□Yes □No Ifyes,attachexplanationandcorrectiveaction.
6.Wereanydisbursementsimproperlymade?□Yes □No Ifyes,attachexplanationandcorrectiveaction.
Transaction#2
1.ClientName/Matter:______________/________________DateRangeofDisbursement(s)__________:__________
2.Doesclientledgershowanegativebalance?
□Yes□No Ifyes,attachexplanation andcorrectiveaction.
3.Lawyerreviewedthefollowing: StatementofCostsandReceipts □Yes □No
(AttachtoReport)ClientLedger□Yes □No
CancelledChecks(orimagesthereof)□Yes □No
Other_________________________□Yes □No
4.Didthetransactioninvolvemultipledisbursements? □Yes □No
Numberofdisbursements_________________
5.Areanydisbursementsoutstanding?□Yes □No Ifyes,attachexplanationandcorrectiveaction.
6.Wereanydisbursementsimproperlymade?□Yes □No Ifyes,attachexplanationandcorrectiveaction.
Transaction#3
1.ClientName/Matter:______________/________________DateRangeofDisbursement(s)__________:__________
2.Doesclientledgershowa
negativebalance?□Yes□No Ifyes,attachexplanationandcorrectiveaction.
3.Lawyerreviewedthefollowing: StatementofCostsandReceipts □Yes □No
(AttachtoReport)ClientLedger□Yes □No
CancelledChecks(orimagesthereof)□Yes □No
Other_________________________□Yes □No
4.Didthetransactioninvolvemultipledisbursements? □Yes
□No Numberofdisbursements_________________
5.Areanydisbursementsoutstanding?□Yes □No Ifyes,attachexplanation andcorrectiveaction.
6.Wereanydisbursementsimproperlymade?□Yes □No Ifyes,attachexplanationandcorrectiveaction.
LawyerCertification
IcertifythatIpersonallyrandomlyselectedtheabovetransactions,thatIpersonally
conductedthereview,andthatall
discrepanciesshallbeinvestigated,identified,andresolvedwithintendaysofthis review.
_________________________ ___________________________ _____________ ______________________
LawyerNameSignatureDateFirmName
click to sign
signature
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