United States District Court

Northern District Of Illinois

Local Rules

Form LR83.28. Declaration of Admissions to Practice Required by LR83.28(d)

DECLARATION OF ADMISSIONS TO PRACTICE

In Re _______________________________

Disciplinary No. ________

I, _________________________, am the attorney who has been served with an order to show cause why disciplinary action should not be taken in the above captioned matter.

I am a member of the bar of this Court.

I have been admitted to practice before the following state and federal courts, in the years, and under the license record numbers shown below:

I declare under penalty of perjury that the foregoing is true and correct.

Executed on __________________________

(Date)

__________________________________

(Signature)

___________________________________

(Full name - typed or printed)

___________________________________

___________________________________

__________________________________

(Address of Record)

This declaration must be signed, and delivered to the court with the attorney's answer to the order to show cause or any waiver of an answer. Failure to return this declaration may subject an attorney to further disciplinary action. Under 28 U.S.C. 1746, this declaration under perjury has the same force and effect as a sworn declaration made under oath.