HTML Preview Retirement Certificate page number 1.
Revised: 01/2015, CN: 11621 page 1 of 1
New Jersey Lawyers’ Fund for Client Protection
P.O. Box 961
Trenton, NJ 08625-0961
Certification of Retirement -
Legal Services Volunteer
For The Calendar Year
The retired exemption from payment is as defined, without alteration. We cannot grant the
exemption if the language of this certification is altered or if “January 31” is deleted and a
later date substituted.
I, _______________________________________________, Esq., of full age, say:
Print Name
1. I am an attorney at law licensed to practice in the State of New Jersey;
2. I hereby request exemption from payment to the New Jersey Lawyers' Fund for Client
Protection for the calendar year(s) indicated pursuant to Rule 1:28-2 because I am
“retired completely from the practice of law” in every jurisdiction. I understand that
attorneys are not exempt from payment solely by virtue of being out-of-state or exempt
from pro bono assignment;
3. My only participation in any aspect of legal practice is by providing qualifying pro bono
service as defined by R. 1:21-11(a) for Legal Services of New Jersey and the associated
legal regional programs; for a certified organization under R. 1:21-11(b), or for an
organization otherwise approved by the Supreme Court.
4. Other than as stated in paragraph 3, I am either unemployed or the employment in which
I engage is not in any way related to the practice of law. I do not draft or review legal
documents, render advice on the law or legal assistance, teach law, or serve in a court
system in any capacity, in any jurisdiction. This is an accurate description of my
activities at least since January 31 of the year for which exemption is sought;
5. I understand that I have an ongoing duty to immediately inform the Fund if I no longer
qualify for the exemption granted;
6. I understand that I will remain officially retired until I inform the Fund otherwise;
7. I understand that it is my obligation to keep my address current with the Fund and to
respond to the Annual Attorney Registration and Billing Form.
I certify that the foregoing statements made by me are true. I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
Date:
Signature:
Clear Form
Save Form
Print Form