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STATEMENT OF SPONSORING ATTORNEY I hereby certify that [am a licensed member of the bar of the State of and that I employ or supervise I authorize to represent me and request that as my representative she/he be allowed to interview and correspond with , Federal Register Number . who ts currently confined at MDC Brooklyn/ MCC New York, I further certify that is aware of the responsibtlity of her/his role as my representative and is able to meet this responsibility. I pledge that I will supervise my representative's activities. I accept personal and professional responsibility for all acts of my representative which affect the institution, its inmates or staff. Attorney’s printed name: Address: Telephone Number: Attorney's Signature: Date Completed: Page 8 of 10 Revised 2/01/08 DOJ-OGR- 00023774