EMPLOYMENT (please check one):
STATE OF COLORADO SUPREME COURT
OFFICE OF ATTORNEY REGISTRATION
1300 Broadway, Suite 510
Denver, CO 80203
(303) 928-7800
ATTORNEY NAME (PRINT/TYPE your name exactly as you want it to appear on your license):
First Middle Last Suffix (Jr., II, III)
(Use full middle name only if you want it on your license)
WHICH ADDRESS DO YOU PREFER TO USE AS MAILING?
BusinessHome
BUSINESS:
HOME: (WILL NOT BE PUBLIC)
Business/Firm Name Street
Street
Suite
Apt
P.O. Box
P.O. Box
City
City
Phone Number
Phone Number
State
State
Zip Code
Zip Code
Ext.
Fax Number
email
Male
Female
Date of Birth (Required)
FOR OFFICE USE ONLY
Attorney Reg. #:
Date of Admission:
InactiveActive
STATUS (required):
("Inactive status" may be selected by attorneys who will not be engaged in the practice of law in Colorado.)
Have you ever held a limited license in Colorado
Yes No
COURT: (PUBLIC AND MUST BE FILLED IN IF ACTIVELY PRACTICING IN COLORADO) (Provide the address Colorado courts should use to mail
Business/Firm Name Street Suite
P.O. Box City
State
Zip Code
Phone Number
Ext.
Fax Number
email
PLEASE FILL OUT FORM COMPLETELY AND PERSONALLY DELIVER TO:
email
ALL EMAIL ADDRESS ARE CONFIDENTIAL AND WILL NOT BE PROVIDED TO THE PUBLIC
Teaching
Private Attorney (firm 51+ attys)
MagistrateGovernment Counsel
District Attorney Law Clerk
Private Attorney (firm 11-50 attys)
Retired From Practice
Private Attorney (firm 2-10 attys)Judge AdvocateCounty Attorney
City Attorney Judge Other-Government
Public Defender
Private Attorney (Sole Practitioner)
Other
House Counsel
Attorney General
Pursuant to § 26-13-126(3), 8 C.R.S. (1998), C.R.C.P. 227, and the federal "Family Support Act of 1988" and the
federal "Personal responsibility and Work Opportunity Reconciliation Act of 1996," the Colorado Supreme Court
requires all attorneys and applicants to answer whether you have been ordered to pay child support.
Check one and sign below.
I hereby certify that I am NOT UNDER ANY COURT ORDER to pay child support.
I hereby certify that I am IN COMPLIANCE with respect to any child support orders.
I hereby certify that I am NOT IN COMPLIANCE with respect to any child support.
Attorney's Signature
Date
ALSO LICENSED IN:
State
State
State
State
Date
Date
Date
Date
Compliance Statement for Rule 1.15 A-E - COLTAF
THE UNDERSIGNED DECLARES COMPLIANCE WITH COLORADO RULE OF PROFESSIONAL CONDUCT 1.15 (INTEREST ON CLIENT
TRUST ACCOUNTS) AS FOLLOWS:
I or my law firm have established one or more interest-bearing accounts for client funds in a financial institution approved by
the Supreme Court Regulation Counsel with interest payable to the Colorado Lawyer Trust Account Foundation (COLTAF),
except those client funds held with interest payable to the client. Client funds are held in:
I am exempt from the requirement to establish a COLTAF account because:
A COLTAF account is not feasible for reasons beyond my control:
I do not receive, maintain or disburse client funds in Colorado.
All client funds are deposited in trust accounts with interest payable to the clients.
ALAS (Attorneys’ Liability Assurance Company)
ALPS (Attorneys’ Liability Protection Society)
CNA (Continental Casualty)
Travelers (St. Paul Mercury Insurance Company)
AmTrust (Wesco Insurance Company)
Indicate carrier if covered:
Other
Account Name
Account Number
Financial Institution
City
Specify:
No
Yes
Yes No
Are you in private practice?
Malpractice Insurance
Are you currently covered by Professional Liability Insurance and do you intend to maintain coverage?
I certify that I completed my registration statement and that the answers provided are accurate.
I understand that my annual registration is not complete until the Court has received my annual registration fee payment.
I understand that pursuant to C.R.C.P. 227(b) I must provide the Office of Attorney Registration with a supplemental statement of change in the
information previously submitted, within 30 days of any changes. Such changes include changes to my registered mailing address, phone number, email,
trust account information, child support payment status, or professional liability insurance coverage status.
CERTIFY STATEMENTS: Please certify that the above marked statements are true and correct by signing below:
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