A compliance declaration filed under BR 8.3 shall be in substantially the following form:
COMPLIANCE DECLARATION
In re: Application of
______________ ________________
(Name of attorney) (Bar number)
For reinstatement as an active/inactive (circle one) member of the OSB.
1. Full name________Date of Birth _______2. Residence address ________ Telephone _______3. I hereby attest that during my period of suspension from the practice of law from ______ to _______, (insert dates) I did not at any time engage in the practice of law except where authorized to do so.4. I also hereby attest that I complied as directed with the following terms of probation: (circle applicable items) a. abstinence from consumption of alcohol and mind-altering chemicals/drugs, except as prescribed by a physicianb. attendance at Alcoholics Anonymous meetingsc. cooperation with Chemical Dependency Programd. cooperation with State Lawyers Assistance Committeee. psychiatric/psychological counselingf. passed Multi-State Professional Responsibility examg. attended law office management counseling and/or programsh. other - (please specify)i. none required 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)
Rule 12.9 established by Order dated March 13, 1989, effective 4/1/1989. Rule 12.9 amended by Order dated February 5, 2001. Former Rule 12.9 redesignated as Rule 13.9; Rule 13.9 amended by Order dated May 3, 2017, effective 1/1/2018. Rule 13.9 amended by Order dated May 22, 2019, effective 9/1/2019. Rule 13.9 amended by Order dated December 26, 2023, effective 1/1/2024.