§ 89.275. Completion of questionnaire by respondent-attorney.

 (a)  General rule. If the petition for reinstatement does not have attached thereto a fully completed Form DB-36 (Reinstatement Questionnaire), the Office of the Secretary shall forward to the formerly admitted attorney four copies of Form DB-36 which shall require such attorney to set forth fully and accurately the following information and such other information as the Office of Disciplinary Counsel may require:

   (1)  Name, address, age and residence of the respondent-attorney.

   (2)  Name, address, age, residence, number and relationship of dependents of the respondent-attorney.

   (3)  If the formerly admitted attorney was disbarred or suspended, the offense or misconduct upon which the disbarment or suspension was based, together with the date of the disbarment or suspension order and the caption and docket number of the proceeding in which entered. A certified copy of the disbarment, suspension or transfer to inactive status order shall be attached to the questionnaire.

   (4)  The names and addresses of all complaining witnesses in any proceedings which resulted in disbarment or suspension and the names of:

     (i)   the hearing committee of the Board, or the local grievance committee, committee of censors or other similar body existing prior to the establishment of the Board, which heard the evidence in the disciplinary proceedings; and

     (ii)   the trial judge and prosecuting attorney, if disbarment or suspension was based on conviction of a crime.

   (5)  The nature in detail of the occupation of the respondent-attorney during the period of disbarment, suspension or inactive status with names of all partners, associates in business, and employers, if any, and dates and duration of all such relationships and employments.

   (6)  A statement showing the approximate monthly earnings and other income of the respondent-attorney, and the sources from which all such earnings and income were derived during such period, or during the ten years preceding the filing of the petition for reinstatement, whichever is less.

   (7)  A statement showing all residences maintained by the respondent-attorney during the ten years preceding the filing of the petition for reinstatement, with the names and addresses of landlords, if any. The statement shall also indicate the county in which any such residence in Pennsylvania is located.

   (8)  A statement showing all financial obligations of the respondent-attorney at the date of the filing of the petition, together with the dates when such obligations were incurred and the names and addresses of all creditors.

   (9)  A statement showing the dates, general nature and final disposition of every civil action during the period of disbarment, suspension or inactive status wherein the respondent-attorney was either a party plaintiff or defendant or in which such attorney had or claimed an interest, together with dates of filing of complaints, titles of courts and causes and the names and addresses of all parties plaintiff and defendant, names and addresses of attorneys for said parties and of the trial judge, or judges, and names and addresses of all witnesses who testified in such actions.

   (10)  A statement showing dates, general nature and ultimate disposition of every matter involving the arrest or prosecution of the respondent-attorney during the period of disbarment, suspension or inactive status for any crime, whether felony or misdemeanor, together with the names and addresses of complaining witnesses, prosecutors and trial judges.

   (11)  A statement as to whether or not any applications were made during such period for a license requiring proof of good character for its procurement; and as to each such application, the dates, the name and address of the authority to whom it was addressed and the disposition thereof.

   (12)  A statement of any procedure of inquiry, during said period, concerning the standing of the respondent-attorney as a member of any profession or organization, or holder of any license or office, which involved the censure, removal, suspension, revocation of license, or discipline of the respondent-attorney; and as to each, the dates, facts, and the disposition thereof, and the name and address of the authority in possession of the record thereof.

   (13)  A statement as to whether or not any charges of fraud were made, or claimed, against the respondent-attorney during the period of disbarment, suspension or inactive status whether formal or informal, together with the dates and names and addresses of persons making such charges.

   (14)  A statement of any financial or other action taken by the respondent-attorney in the nature of restitution or other appropriate relief.

   (15)  If the respondent-attorney has been disbarred or suspended for more than one year or has been on inactive status for more than three years, a statement of the dates, locations and names of the courses or lectures taken in satisfaction of the requirements of §  89.279 (relating to evidence of competency and learning in law).

   Official Note

   For purposes of allowing the Office of Disciplinary Counsel to begin its investigation of the petition for reinstatement, the Office of the Secretary will accept a preliminary questionnaire that lists courses or lectures that the respondent-attorney is registered to take in the future if proof of that registration, such as receipted bills or canceled checks, is attached to the questionnaire. The questionnaire, however, will not be considered completed and properly filed for purposes of commencing the running of the time periods in §  89.273 (relating to procedures for reinstatement) until the respondent-attorney has actually attended those courses or lectures.

   (16)  An itemization of any costs taxed under §  89.209 (relating to expenses of formal proceedings) and any required restitution to the Lawyers Fund for Client Security under Enforcement Rule 531 (relating to restitution a condition for reinstatement), and a statement that all of those amounts have been paid in full.

   (17)  A concise statement of facts claimed to justify reinstatement to the bar of this Commonwealth.

 (b)  Effect of questionnaire. The questionnaire shall bear a notice under 18 Pa.C.S. §  4904(b) (relating to statements ‘‘under penalty’’) to the effect that false statements made therein are punishable, and shall become a part of the record in the reinstatement proceeding.

   The provisions of this §  89.275 amended January 14, 1982, effective January 16, 1982, 12 Pa.B. 266; amended May 17, 1991, effective May 18, 1991, 21 Pa.B. 2333; amended April 26, 1996, effective immediately, 26 Pa.B. 1984; amended July 13, 2001, effective imediately, 31 Pa.B. 3731. Immediately preceding text appears at serial pages (214517) to (214519).