STATE OF TEXAS



MEDINA DISTRICT AND COUNTY COURTS PLAN

ATTORNEY VERIFICATION OF CLE SELF-STUDY CREDITS

THE STATE OF TEXAS

COUNTY OF MEDINA

I hereby swear or affirm that I have completed self-study activities in the following areas: __ hours in criminal law; __ hours in juvenile law. I understand that credit for self-study may include actual time spent viewing or listening to audio, video or digital media, reading legal articles, advance sheets, case summaries or CLE course materials, judging or critiquing mock trials, and all individual study of legal materials or information.

This verification is submitted pursuant to the Medina District and County Courts Plan for timely appointment of counsel to represent indigent defendants and juvenile respondents. I understand that a false statement or representation regarding self-study activities will result in my removal from the list of attorneys approved to represent indigent defendants and juvenile respondents in the Medina County District and County Courts.

Signed this the __ day of ______________, 2____.

____________________________________

Printed Name:________________________

Bar Card No._________________________

Address:_____________________________

Subscribed and Sworn to before me this the __ day of _____________, 2_____.

_______________________________________

NOTARY PUBLIC / PERSON AUTHORIZED

TO ADMINISTER OATHS

Print Name:_____________________________

Capacity:_______________________________

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