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D PROFESSIONALADMISSIONS #xAxI#Axx aW)"  ````  @5.@a5.#xAx#Axx \R@2#  @5. @ \Listallcourts(includingstatebaradmissions)inwhichyouarepresentlyadmittedtopractice,givingthedatesof 2$ admissionineachinstance:#xAx#Axx A7$z% A =3!& =A9Ax CourtorAdministrativeBody #9A9#A99 <2$' < =3!( = DateofAdmission #9A9#A99 A7))   A =3!v** = \R$,  @6.@\6.#9A9#A99 \R@:-  @6. @ \Haveyoueverbeendisciplinedorcitedforabreachofethicsorunprofessionalconductbyanycourt,administrativeagency,#9A9#A99 :. barassociation,orotherprofessionalgroup?#9A9#A99  #9A9m#A99 A7$n/ A 0&!0 0#9A9#A99p#9A9n#A99 4*1 4Yes#9A9#A99 3)$2 3p  __#9A9-#A99__  5+3 5No.Ifyes,giveparticulars.#9A9#A99   $  |    ,      4! #9A9#A99_  ԍ 4!  4! #9A93#A99ԍ # #9A9#A99ԍ # #9A9#A99#9A9K#A99ԍ #9A9#A99__  B8*4   B 4*!B5 4#AxA9q# 3)j8 3 :0!B9 : J````5!B: J LAWPRACTICE #xAx#Axx aW) v;  ````  @7.@a7.#xAx!#Axx \R@"<  @7. @ \Providethefollowinginformationforyouremploymentforthepastfiveyears.#xAxQ"#Axx A7$"= A =3!p#$> =A9AxOrganization#9A9=##A99 <2$p#$?" < =3!p#$@" = @ Address0 @ #9A9($#A99 <2$p#$A" < =3!p#$B" =ЀPosition#9A9%#A99 <2$p#$C" < 9/!p#$D" 9Dates#9A9%#A99 >4&p#$E"   >#AxA9## 4*!$| F 4 3)%!I 3 4*!$| J 4 3)$| K 3 4*!$| L 4 3)$| M 3 6,!$| N 6 VL$| O   @8. @V8.#xAx&#Axx \R@H'"P   @8.  @ \Describethegeneralnatureofyourcurrentpracticeincludinganylegalspecialtiesandcharacterofyourtypical H'"Q clients;also,ifyourpracticeissubstantiallydifferentnowthanpreviously,givedetailsofpriorpractice.#xAx(#Axx <2$'#R < 4*!4)$S 4 XN)|%U  "@9."@X9.#xAx}*#Axx \R@ +&V  "@9. "@ \#xAx+#AxxԀWhatpercentageofyourcourtappearancesinthelastfiveyearswereincriminalcasesin:#xAx),#Axx J@) +&W   J @6$x,,(X @1.Federalcourts#xAx,#Axx >`-$x,,(Y > 7-x,,(Z` 7% J@)x,,([   J @6$-)\ @2.Stateorlocalcourts >`-$-)] > 7--)^` 7%#xAx-#Axx g])-)_   &$@10.$@g_10.#xAxt/#Axx ]SA(/*` $@10. $@ ]Duringthepastfiveyears,whatpercentageofyourpracticehas (/*a Ѐbeencriminaltrialpractice?#xAx00#Axx 7-$/p+b 7_____ 7-(/*c 7%_ g])(/*d &   &@11.&@g27 2@C8o\\d\\d8 2  11.#xAxB1#Axx_ ]SAd &@11. &@ ]Howfrequentlyhaveyouappeared d incourt?#xAx2#Axx 7-$D  7_______ 7-d 7timespermonth.#xAx3#Axx g])d    (@12.(@g12#xAx4#Axx. ]SAq (@12. (@ ]  a)Haveyoueverbeensuedbya q client?#xAxN5#Axx 3)$Q 3#xAx56#Axx 4*q  4Yes#xAx6#Axx 3)$q  3p q  #xAx#7#Axx 4*Q  4No.Ifyes,giveparticulars. A7)q    A 4*!a 4 8.A  8 =3! M =b)Haveyouoryourprofessionalliabilityinsurancecarriereversettledaclaimagainstyouforprofessional  M malpractice?#xAx7#Axx F<)-    F 0&! 9 0p#xAx9#Axx 4* 9 4 @u Yes#xAx:#Axx_  ԍ w p#xAx;#Axx_  _ 4*% 9 4#xAxx;#Axxp_  _#xAx<#xx#xx<#xx#xx<#Axx#xAx=#Axx8#xAxP=#Axx#xAx=#Axxo=#xAx=#Axx_  _ 5+ 9 5No.Ifyes,giveparticulars,includingtheamountsinvolved.#xAx>>#Axx A7) 9   A 4*!  4 D````/q%  ND CONDUCT #xAx?#Axx bX)}  N ```` *@13.*@b13.   #xAx&@#Axx ]SAg  *@13. *@ ]5  Haveyoueverbeenchargedinanycivilorcriminalproceedingswithconductallegedtoinvolvemoralturpitude,   dishonesty,orunethicalconduct?#xAx@#Axx A7$g  qA0nA 0&! ! 0B#xAxCB#Axxp#xAx.C#Axx8 4* " 4CYes8#xAxtC#Axx 3)$ # 3Cp  $ #xAx)D#8Axx 4*S% 4D#xAxD#AxxNo.Ifyes,giveparticulars.#xAxiE#Axx bX) & q  ,@14.,@b14.#xAxE#Axx ]SA|0' ,@14. ,@ ]a)Haveyoueverbeenarrested,charged,orconvictedforviolationofanyfederallaw,statelaw,countyor |0( municipallaw,#xAxpF#AxxԀregulation,orordinance?#xAxG#Axx <2$) < 0&!h* 0#xAxG#Axxp#xAxH#Axx 4*h+ 4Ye#xAxH#Axxs 3)$h, 3p h- #xAxfI#Axx 0&. 0No. h/ #xAxI#Axx =3!0 =#xAxJ#AxxIfyes,givedetails.(Donotincludetrafficviolationsforwhich#xAxK#AxxԀafine#xAxK#AxxԀof$200orless h1 wasimposedunlessitalsoincludedajailsentence.)#xAxK#Axx <2$2 < 4*!T3 4 3)T4 3 =3!`5 =b)Haveyou,toyourknowledge,everbeenunderfederal,stateorlocalinvestigationforpossibleviolationofa `6 criminal#xAxiL#AxxԀstatute?#xAxN#Axx A7$@7 DA 0&!L8 0#xAxdN#Axxp#xAxO#Axx 4*L9 4#xAx]O#AxxYes#xAxO#Axx L:  @u #xAxP#Axx 3)$,; 3#xAx{P#Axxp L< #xAxP#Axx 0&,= 0No. L> #xAxKQ#Axx =3!,? =#xAxQ#AxxԀIfyes,giveparticulars.#xAxTR#Axx bX)L@ D  .@15..@b15. TJAp$B .@15. .@ T#xAxR#Haveyouinthelast10years(_i_)beenhospitalizedduetoinjuryorseriousmentalorphysicalillnessordrugor p$D alcoholaddiction,or(ii)beenpreventedfromworkingorotherwiseincapacitatedforaperiodinexcessoften  E daysduetoinjuryorillness,drugoralcoholaddiction?Ifso,givetheparticulars,includingthecauses,the  LF dates,theplacesofconfinement,andthepresentstatusoftheconditionswhichcausedtheconfinementor ,!G incapacitation.Axx !tH #xAxU#Axx D````/|#0K D SUPPLEMENTALINFORMATION #xAxEV#Axx g])$ L  ```` 0@16.0@g_16.#xAxV#Axx_ ]SA*&!M 0@16. 0@ ]  Stateanyachievementsoractionsyouhaveaccomplished,demonstratingyourcommitmenttoequaljusticeunder *&!N thelaw.#xAxW#Axx A7)&r"O   A1X 4*!(#P 4#xAxX#Axx TJ(d$R 1@17.1@T_17.#xAxY#Axx_ ]SA*%S 1@17. 1@ ]Stateanyotherpertinentinformationreflectingpositivelyoradverselyonyouwhichyoubelieveshouldbe *%T disclosed.#xAx[Z#Axx *P&U  ]S$0+&V 2@18.2@]18. ]SA,<(W 2@18. 2@ ]LanguageProficiency(includingsignlanguage): ,<(X <2$-(Y < 4*!d 4#xAx[#Axx <2D <<#xAx]]#  Axx J@)P <  J] J@)   JIdeclareunderpenaltyofperjurythattheforegoingistrueandcorrect.#xAx]#Axx J@)0   J J@) <   JSignatureofApplicant#xAx_#Axx G`6$  G <2$  `  <  Date#xAx`#Axx J`9!    J?53    6 ` ?#xAx`# F     N      V     *[`\d7ddd add add dd ,dd ,dd dd xdd xdd Bdd Bdd dd dd wdd wBdd Bdd Bdd B0dd 0dd 7dd 7 `95%5%,dd ,dd +  '\  \   ' 0&! t  0(8   (*:`;dddd dd [`\5%5%,dd +  ,"x, x,  <, K````6&  <  K   CONFIDENTIALITYSTATEMENT Axx C9&    ````  C    Thisformwillbekeptconfidentialandwillbeexaminedonlybythejudgesandstaff_of_Ԁthedistrictcourt.#xAxe#Axx6,*n"      6 #xAx'g# Axx`f   F AXXAxSubmitthisformto:#AxXAXg#  j 0 F ChiefMagistrateJudgeSamuelAlbaF5%F5% 0 F Room260F5%F5% 0 F FrankE.MossUnitedStatesCourthouseVF5%F5% 0 F 350SouthMainStreetfF5%F5%  F SaltLakeCity,UT84101 * .#xAxg#Axx  g#xAxi#Axx