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REQUEST TO BE PLACED ON THE PRIVATE ATTORNEY LIST UNDER TITLE 74 O.S. SUPP. 1998, SECTION 20i
	All fields are required.
Law Firm Name:
Title:
First Name:
Middle Name:
Last Name:
Bar Number:
Bar Number State:
Subject Areas of Practice:
Address:
City:
State:
Zip Code:
Email Address:
Telephone Number:
Fax Number:

1. Have you had any disciplinary actions or sanctions imposed upon you as an attorney? Yes
No

If Yes, please explain:

2. Are you legal counsel for any pending cases wherein the State of Oklahoma, a State agency, or a State employee, is a party or defendant? Yes
No

If yes, provide the style of the case, the case number and the court in which it is pending, and the party you represent.

3. If you enter into a contract with an agency or official of the executive branch, pursuant to 74 O.S. Supp. 1998, Section 20i, you will agree to provide to the Office of the Attorney General a status report upon any significant development in any litigation or matter in which you are engaged, but not less than every six months, unless otherwise exempted from this requirement by the Office of the Attorney General.
Yes
No

4. If you enter into a contract with an agency or official of the executive branch, pursuant to 74 O.S. Supp. 1998 Section 20i, will you agree to limit your reimbursement for any expenses incurred in such travel in accordance with the provisions of the State Travel Reimbursement Act, 74 O.S. Section 500.1 et. seq., existing statutes relating to state travel, and any applicable rates of per diem?
Yes
No

5. If you enter into a contract with an agency or official of the executive branch, pursuant to 74.O.S. Supp. 1998, Section 20i, do you understand and acknowlege that, pursuant to 74 O.S. Supp. 1998, Section 18(b)(3), the Office of the Attorney General may appear in any action in which the interests of the State of Oklahoma or the people of the State of Oklahoma are at issue, and, if advisable and in the best interest of the State of Oklahoma or the people of the State of Oklahoma, take and assume control of the prosecution or defense of the interests therein?
Yes
No