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Please complete the following form and have it notarized. Letters (letter from Disciplinary Committee) or Certificates of good standing will not be issued without this form. Send form and check for $25.00 (make check payable to the State Bar of Texas) with your request. The Office of the Chief Disciplinary Counsel, does not accept credit cards, so you must submit a personal check or money order. Forward all information to the address listed below: Chief Disciplinary Counsel P. O. Box 12487 Austin, Texas 78711




Indicate where you would like the certificate or letter mailed. If it is mailed to the entity requesting this information, indicate if you would like a copy sent to you as well. If you are asked to fax the information back, please put original form and fee in the mail to the attention of the Office of the Chief Disciplinary Counsel at the address listed above. Fax number is (512) 453-6667 If you need the information returned to you by Federal Express or overnighted, you must include a return overnight slip with your request and your fed-ex account number. In the event that you have a very short deadline you may overnight your information to the State Bar of Texas at the physical address listed below, otherwise send it by regular mail to the address listed above: Office of the Chief Disciplinary Counsel 1414 Colorado St., 2nd Floor Austin, Texas 78701





Please allow 2-3 working days for processing of your certificate or letter. If you have any questions you may contact this office at (877) 953-5535 extension 100.

State Bar of Texas Authorization and Release

I, ______________________________(name), born at ________________________(city,state)

on (birth date)

, State Bar Card Number

hereby apply for a statement concerning the status of disciplinary action pending or of record on me and consent to the examination of my grievance record for that purpose. I agree to give any further information which may be required in reference to my past record. I understand the many records relating to grievance matters are confidential. I hereby waive any confidentiality in order to obtain the letter of good standing. I specifically consent to the letter stating the existence of any unresolved matters pending before a grievance committee of the State Bar of Texas and/or any private reprimands on my record. I hereby release, discharge and exonerate the State Bar of Texas, its agents or representatives and any persons so furnishing information from any and all liability of every nature and kind arising out of the furnishing of information in the letter of good standing requested by me.

State of _______________________ County of ______________________

(Signature of Requestor)

Subscribed and Sworn to before me this

day of

A.D., 200

(Notary Public)

My Commission Expires __________________ (Date)