APPENDIX A - REQUEST FOR INACTIVE STATUS

Name: ______________________________________

Address: ______________________________________

______________________________________

______________________________________

I certify I will no longer be actively practicing law in North Dakota and request that I be placed on inactive status. I have reviewed Rule 4(b) of the North Dakota Rules for Continuing Legal Education and understand: 1) I will no longer be licensed to practice law in North Dakota; and 2) the ethical obligations associated with my inactive status. I also certify that I am not subject to any disciplinary proceedings or investigations in any jurisdiction.

Dated this _____ day of _____________, 19___.

Signed by: _____________________________

Subscribed to and sworn before me this ____ day of ____________, 19___.

_________________________________________
Notary Public

My commission expires: __________________

(Adopted on an emergency basis August 17, 1993; amended and re-approved February 2, 1994; amended effective November 1, 2000.)