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AFFIDAVIT OF INACTIVE/RETIRED STATUS AFFIDAVIT OF INACTIVE/RETIRED STATUS

AFFIDAVIT OF INACTIVE/RETIRED STATUS - PDF document

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Uploaded On 2015-08-12

AFFIDAVIT OF INACTIVE/RETIRED STATUS - PPT Presentation

F OR THIS AFFIDAVIT TO BE APPROVED F OR FY 20 15 201 6 THE ORIGINAL MUST BE RECEIVED NO LATER THAN August 31 2015 To the Trustees of the Client Protection Fund of the Bar of Maryland 1 I hav ID: 105945

F OR THIS AFFIDAVIT

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AFFIDAVIT OF INACTIVE/RETIRED STATUSFiscal Year 2021 OR THIS AFFIDAVIT TO BE APPROVED FOR FY THE ORIGINAL MUST BERECEIVEDNO LATER THANAugust31, 20 I have read Regulation i.(reproduced on the reverse side hereof), and I affirm my compliance therewith andmy entitlement to your “inactive/retired” status for the following reasons (every box must be checked [ ] . I understand thatshoulthis status change be approved, the effective date will be July 1, 20 I understand that I need not pay the FY2assessment if the original affidavit is received and approved by CPFno later than 4. OPTIONAL:As an inactive member yomay electto become a voluntary contributor. As such you would be billed only for the amount you designate below: I do not wish to be a voluntary contributor I desire to become voluntary partial contributor andenclosethe $20 contribution(CPF portion only) My current address, telephone number and my social security number are shown below:NAMESOCIAL SECURITY NO.STREET ADDRESSCITY, STATE, ZIP CODEWORK PHONE State ofuntyor City)of____________________On this ____day of _______________, 20___, before me, the undersigned officer, personally appeared __, known to me (or satisfactorily proven) to be the person(s) whose name is subscribed to within the instrument and ack MailOriginalForm toCPF, 200 Harry S. Truman Pkwy, STE 350, Annapolis, MD 21401 CPF APPROVEFFECTIVE DATE REGULATION i . 5 OF THE CLIENT PROTECTION FUND OF THE BAR OF MARYLAND . Assessments.The Fund shall maintain a status of "Inactive/Retired. An affidavit of inactive/retired status must be completed, notarized and received in compliance with date restrictions as indicated on the affidavit form. Those lawyers approved for this status shall not be charged assessments orlate fees for any fiscal year once they are approved.All Regulations of the Fund can be viewed at our website:www.courts.state.md.us/cpfYou will receive written confirmation upon approval of the status change C lient Protection Fund of the Bar of Maryl and Melissa M. Higdon, Executive Director 200 Harry S. Trum an Pkwy ., S uite 350 Annapolis, MD 21401 410 - 630 - 8140 Form Revise02/2020