■ ningina 2013-2014 THE FLORIDA BAR ANNUAL MEMBERSHIP FEES Mait0StiffaPWAitriktkOOKMEINIWMTEMINSAWMALt All members of The Florida Bar must make a selection from one of the choices below. Detailed InWuctions can be reviewed on the Ethics Opinions page of The Florida Bat's website. I certify that I have read the rules applicable to lawyer trust accounts and property safekeeping in chapter 5 of the Rules Regulating The Florida B81 bomv.toridabacorgirulesictapterfl and that el am reauirec to maintain a trust account and f am a occollance with the trustaccount and &napery safekeeong newt, (1) O LaaralagyjrpoU0 mantairitt because I do not receive or hold funds or property from clients or third parties in connection with legal representation. (2) (Dian not in oamollance with he trust account and property &Skewing rules. Attached Is an exploration ol the way In which i did not comply with the trust account and property safekeeping rules. (3) .7.1,7 f lifikraffOtio-A.efro.rplAF:cklyst1420.01VESsirMatiarkgRikrau.441 Os .ire to comptotely bledom trio coon whom applicable. Plea onW awe nvortor o NOS haute alagatraglaQ Q=12181kkUntjAleactaltaTheESMSE 1. I have personany provided pro bono legal services: (a) iron my own.' (b) O "through an organized legal aid program:* 2. My firm provided pro bono services colectively under a plan with the following Florida Circuit Pro Bono Commidee: (circuit I) and I was &located: 3. I have contributed to a 'egal aid organization. Pease enter amount. WS dons $ 4. I have not provided pro bona legal services to the poor this year or made a contribution to a &gal ad organiuttion. 5. During he repotting period, I was deferred from the provision of reporting pro bono legal services to tne pea because I am: (choose one) O a member of the judiciary (a) Q a governmental lawyer prohibited by statute, rule Q retired (d) O Judicial staff (b) or repletion from providing services (c) O inactive (e) 6. None of the above apples to me, but I have provided legal seMces to the poor In the following special mamet (see Instructions) tan tows IL, I l i , I I I I I I I I I I I I I I I I I I 1 1 1 1 1 1 1 1 I I cpmm_yNrrrit4kW.W.Y.9.01WaolfatiltgiotitAkikffriSAILin VOLUNTARY SURVEY for rho purpose of showing the involvement of lawyers in community service. lie sure to completely blacken the circle corresponding to your envy. • Service to the legal community • SeMco to religious orgrizabons • Service to civic organizations • Service to ether charlties/schools LI I Rows Noun ton hew Answering this question does not constitute compliance with required pro bono response. Please net the ntrebera WAS Mom s:f4:,- ±:tinoivitiokrriiwtvailf.4,40-re..-;704,4N Membership data can be changed any Ume at wwwiloridabar.org. CHANGE OF ADDRESS: Me:tubers Aril promptly notify the Bar of Wang% lawman; to RS 1.33, Rues Regulating The Florida Bar. All such data contained in tour membership reord is public irformatian. CURRENT BUSINESS E-MAIL ON FILE WITH TFB: jgoldbergereagwpa.00m Firm (optional) Mailing Address Oty/StateRlp Physical Address City/State/73p Business Telephone Business E-mail Address I I I I I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 I I I ' I I I I I I I I I I } I I I I } I I I I I I I INI I I J I I I I I I I I I I I I I I I I I I I I i l l I I (Street address of your office must be prodded If different from mailing address ) I IH1 1 1-1 1 1 1 I I I I-I I I , I I I- I I I-I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I I I I I I I I I I 1 1 COMPLETE FRONT AND BACA AND RETURN ENURE FORM 1)2 MAI WAIN MEMBERSHIP STATUS • EFTA00617486