Form 5210/06A Legal Servicees Agreement Amendment Continuation Sheet

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OMB NUMBER: 3064-0122
EXPIRATION DATE: 03/31/2007

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Federal Deposit Insurance Corporation

LEGAL SERVICES AGREEMENT (LSA) AMENDMENT
(Continuation Sheet)

ADD (A)
OR
DELETE (D)

BILLABLE INDIVIDUAL
(First, Middle, Last, Suffix)
Alphabetical Order

STATE
LICENSES

POSITION
Partner (P)
Associate (A)
Paraprofessional (PP)
Specify Other Position
(O)

YEARS
IN
PRACTICE

MINORITY
STATUS
Asian American (A)
Black American (B)
Hispanic American (H)
Native American Indian (N)

Page

GENDER
(M or F)

STANDARD
RATE

PERCENT
%
DISCOUNT

of

.

PROPOSED
FDIC
RATE

PAPERWORK REDUCTION ACT NOTICE: Public reporting burden for this collection of information is estimated to average 1.0 hour per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to the Paper Reduction Act Clearance Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, N.W., Washington, D.C. 20429, and the Office of Management and Budget,
Paperwork Reduction Project (3064-0122), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.

FDIC 5210/06A (10-05)