A compliance declaration filed under BR 7.1(g) shall be in substantially the following form:
COMPLIANCE DECLARATION
In re: Reinstatement of
______________ ________________
(Name of attorney) (Bar number)
For reinstatement as an active/inactive (circle one) member of the OSB.
[] I did not at any time engage in the practice of law except where authorized to do so.
OR
[] I engaged in the practice of law under the circumstances described on the attached [attach an explanation of activities relating to the practice of law during suspension].
I HEREBY DECLARE THAT THE ABOVE STATEMENT IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I UNDERSTAND IT IS MADE FOR USE AS EVIDENCE IN COURT AND IS SUBJECT TO PENALTY FOR PERJURY.
(Name)
Or. R. Bar P. 13.10