Revised March 2018
11. I hereby certify that all lawyers identified in paragraphs 9 and 10 are eligible to practice law
in the state(s) in which they are licensed.*
*If the registration statement is signed by a lawyer not licensed in North Carolina, it must be
accompanied by a separate notarized statement from a lawyer with an active North Carolina law
license certifying as to items 9 and 10 (27 NCAC, Subchapter E, Rule .0202(2)(3)).
12. I hereby certify that each lawyer identified in paragraphs 9 and 10 who is not licensed to
practice law in North Carolina will govern his or her personal and professional conduct with
respect to legal matters arising in North Carolina in accordance with the Rules of Professional
Conduct of the North Carolina State Bar.
13. I certify that all professional legal services provided by and through the law firm in North
Carolina shall be provided by a duly licensed active member of the North Carolina State Bar.
14. I certify that the law firm shall be subject to the applicable rules and regulations adopted by,
and all the disciplinary powers of, the North Carolina State Bar.
15. I am licensed and in good standing to practice law in the following jurisdictions:
Jurisdiction License #
16. Attached hereto is a registration fee of $500.
This the ______ day of ________________, 20 ______.
[Title: Director, Officer, Manager, etc.]
I hereby certify that _______________________________ personally appeared
before me this the ______ day of ________________ 20 ______ and stated that he/she
has read the foregoing INTERSTATE and INTERNATIONAL LAW FIRM REGISTRATION
STATEMENT and that the statements contained therein are true.
Witness my hand and notarial seal this the ______ day of ________________,
My commission expires:____________________