Fill and Sign the Nebraska Ethics Advisory Opinion for Lawyers No 17 01 Question Form

ATTORNEY’S FORM TO REPORT POTENTIAL IDENTITY THEFT OR ISSUE COMPROMISING THE ATTORNEY’S PROFESSIONAL REPUTATION For attorneys seeking to inform Nebraska Supreme Court Attorney Services Division, including Counsel for Discipline, that they have potentially been a victim of identity theft or scam. PART A : ATTORNEY INFORMATION The address and email address provided here will be considered the current and preferred address for the attorney. Name: Bar #: Firm/Org.: Date of Birth: Address: Date of Admission: City State ZIP Email: Phone: PART B : INFORMATION ABOUT THE ISSUE OR OCCURENCE Describe what has taken place and the resulting damages or issues. What is your specific concern? Describe what you believe has taken place and include pertinent dates, locations, websites, email addresses and/or individuals you believe to be involved. Provide documents, copies or additional information as attachments to this form as needed. Describe what has occurred as a result of the perceived identity theft or scam. Describe any action you are taking or have taken on this matter. By checking this box and submission of this form, I hereby certify that the information it contains is true and correct. Signature: Date: Digital signatures will not be accepted. Steps Attorney Services will take after verifying submitted information: 1. Notify Counsel For Discipline of identity theft 2. Post public notification on web site Steps Attorney should take: Notify Attorney General consumer protection unit at 402-471-2682 Contact local law enforcement to report the identity theft. NSC Attorney Services Division, 3806 Normal Blvd, Lincoln, NE 68506 HELP DESK: 402.471.3137; fax: 402.471.2512; email: nsc.attrservices@nebraska.gov ASD 3:14 New 04/19