10.3-a-application-declaration-federal.pdf (2024)

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BOARD OF PROFESSIONAL RESPONSIBILITY
OF THE
SUPREME COURT OF TENNESSEE
APPLICATION FOR STATUS CHANGE
PURSUANT TO TENNESSEE SUPREME COURT RULE 9, SECTION 10.3
Pursuant to Tenn. Sup. Ct. R. 9, Section 10.7 (a), an attorney who claims an exemption under Section 10.3
(a),(b),(d) or (e) shall file with the Board an application to assume inactive status and discontinue the
practice of law in Tennessee. An attorney who claims an exemption under Tenn. Sup. Ct. R. 9, Section
10.3(c) shall file an application with the Board for status change. In support of the application, the attorney
shall file an affidavit or declaration under penalty of perjury stating that the attorney is not delinquent in
paying the privilege tax imposed on attorneys by Tenn. Code Ann. § 67-4-1702, is not delinquent in
meeting any of the reporting requirements imposed by Rules 9, 21, and 43, is not delinquent in the
payment of any fees imposed by those rules, and is not delinquent in meeting the continuing legal
education requirements imposed by Rule 21.
The undersigned attorney hereby makes application for the following exemption (please check (one only
please)):
____
____
____
____
____

Section 10.3 (a) – Inactive – Federal
Section 10.3 (b) – Inactive – Retired (pursuant to Tenn. Sup. Ct. R. 9, § 2 (Definitions))
Section 10.3 (c) – Active – Military Exempt
Section 10.3 (d) – Inactive – TN Law School Faculty
Section 10.3 (e) – Inactive – Not practicing in Tennessee

By making this application, I am aware that an attorney who assumes inactive status under an exemption
granted by Section 10.3(a), (d), or (e) shall pay to the Board, on or before the first day of the attorneyâs
birth month, an annual inactive-status fee in an amount equal to one half of the total annual fee set forth in
Section 10.2(c).
Further, I am aware that this change in status exempts me from annual reporting requirements with the
Tennessee Commission on Continuing Legal Education.
_______________________________________

_______________________________________

Printed Name

Signature

_______________________________________

BPR Number (required)

Email address (required)

Instructions to attorney: Complete and return this application and the following affidavit to the Board by
mail (see the address below) or by email (registration@tbpr.org). Please be aware that any registration
requirement due on or before the date your affidavit is received by the Board must be paid before your
status may be changed. You are advised to contact the Tennessee Commission on Continuing Legal
Education to determine the requirements for completion of CLE while your law license is exempt (if any).
Board of Professional Responsibility
ATTN: Registration Department
10 Cadillac Drive, Suite 220
Brentwood, TN 37027-5078

BOARD OF PROFESSIONAL RESPONSIBILITY
OF THE
SUPREME COURT OF TENNESSEE
DECLARATION IN SUPPORT OF REQUEST FOR EXEMPTION
PURSUANT TO TENNESSEE SUPREME COURT RULE 9, SECTION 10.3(a)
I, __________________________, BPR #______________, declare under penalty of perjury, that the
following statements are true and correct:
1.

I wish to claim the exemption afforded by Tenn. Sup. Ct. R. 9, Section 10.3 (a). (Please select
the applicable reason for your request below.)
a. _____ I serve as a justice, judge, or magistrate judge of a court of the United States
of America (federal judge) or
b. _____ I serve in a federal office and am prohibited by federal law from engaging
in the practice of law.

I am not delinquent in meeting any of the reporting requirements imposed by Tenn. Sup. Ct.
Rules 9, 21, or 43;

I am not delinquent in the payment of any fees or penalties imposed by Tenn. Sup. Ct. Rule 9;

I am not delinquent in meeting any continuing legal education requirements imposed by Tenn.
Sup. Ct. R. 21;

I am not delinquent in paying the Professional Privilege Tax imposed on attorneys pursuant to
Tenn. Code Ann. § 67-4-1702; and certify that I have paid all previously assessed Professional
Privilege Tax.

Witness my hand and seal this the _________ day of ______________________________, 20_____.
_______________________________________

_______________________________________

Printed Name

Signature

_______________________________________

BPR Number (required)

Address (Mailing Address Only)

_______________________________________

Email address (required)

City, State, Zip Code

For Board of Professional Responsibility Use Only
Type
Federal

BPR Good
Standing?

Disciplinary
history?

CLE
Objections?

Professional
Privilege
Tax Paid?

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Title	Application for Status Change Pursuant to Tennessee Supreme Court Rule 9, Section 10.3

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