(a) the place and date of such person's admission to practice as attorney and counselor at law; and
(b) his last office and residence addresses; and, within five days after the imposition of sentence, to transmit a certified copy of the judgment of conviction to the clerk of the appellate division of the supreme court in the judicial department in which such person was admitted to practice. Said copy of the judgment shall set forth, in addition to all the facts usually stated therein, the place and the date of admission to practice of such convicted attorney and his last office and residence addresses.
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