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oe t a7 - Has a tax lien or other collection procedure ever been instituted against you by federal, state or local authorities? If do, give particulars. Would a current public review of your tax situation cause you any embarrassment? No. ‘a Have you ever been sued successfully by a client? If so, give particulars. (Treat settling a case as a successful suit.) No. Have you ever been disciplined, reprimanded, or cited for a breach of ethics or unprofessional conduct by, or been the subject of a formal proceeding respecting such conduct before any court, administrative agency, bar association, disciplinary committee, or other professional group? If so, give the particulars. No. a) What is the present state of your health? - Excellent. b) Have you in the past five years had any serious illness, or X d&ncapacity or hospitalizaton that has prevented you from working for two weeks? No. a ¢c) Do you suffer from any impairment of eyesight or hearing or any other physical handicap not fully correctable by mechanical means? If so, give details. No. d) When did you have your most recent general physical examination, and who was the supervising physician? (Give name and full adéress.) _Dr. Freeman H. Cary, U.S. Capitol, Room HE66, Washington, D.C., 20515. September, 1978. e) Are you currently under treatment for an illness or physical condition? If so, give details. No. £) Have you ever been treated for or had any problem with alcoholism or any related condition associated with consumption of alcoholic beverages or any other form of drug addition or dependence? If so, give details. No. id AY