TO: INDIANA SUPREME COURT DISCIPLINARY COMMISSION
30 South Meridian Street
Suite 850
Indianapolis, Indiana 46204
The undersigned, being a duly authorized officer of _______, a financial institution doing business in the State of Indiana, and the agent of the named financial institution specifically authorized to enter into this agreement, hereby applies to be approved to receive attorney trust accounts in the State of Indiana. In consideration of the Indiana Supreme Court Disciplinary Commission's approval of the named financial institution, the institution agrees to comply with the reporting requirements for such institution as set forth in Indiana Admission and Discipline Rule 23, § 29(b) through (g) and the Rules Governing Trust Account Overdraft Reporting promulgated by the Disciplinary Commission, as now in effect and as hereafter amended from time to time.
Specifically, the named financial institution agrees:
This agreement shall apply to all branches of the named financial institution and shall not be canceled except upon thirty (30) days notice in writing to the Executive Secretary, Indiana Supreme Court Disciplinary Commission, 115 West Washington Street, Suite 1165, Indianapolis, Indiana 46204.
Name, Address, and Telephone Number of Contact Person for Financial Institution:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DATE: ______________
__________________________________________________
Signature of Authorized Official
CORPORATE
__________________________________________________
Printed or Typed Name of Authorized Official
SEAL
__________________________________________________
Title or Position of Authorized Official
ACKNOWLEDGMENT
STATE OF INDIANA )
) ss:
COUNTY OF _________ )
On the ____ day of _______, 20___, before me, a Notary Public in and for the State of Indiana, personally appeared the above-named individual, known to me to be the person executing the foregoing instrument, and acknowledged and executed said instrument as his/her free and voluntary act and deed.
___________________________________
Notary Public (signature)
___________________________________
Notary Public (printed or typed)
My Commission Expires: ____________
County of Residence: ____________
ACCEPTANCE
The named financial institution is hereby approved by the Indiana Supreme Court Disciplinary Commission as a depository for attorney trust accounts in the State of Indiana until such time as this agreement is canceled upon thirty (30) days' written notice to the Commission by the institution or is revoked by action of the Disciplinary Commission.
DATE: ______________
__________________________________________________
Executive Secretary
Indiana Supreme Court Disciplinary Commission
Ind. R. Att'y Trust Acct. A