Application Of Attorney For Admission To Practice Pro Hac Vice

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA Plaintiff(s)/Petitioner(s), vs. CASE NO: Application of Attorney For Admission To Practice Pro Hac Vice Pursuant to LRCiv 83.1(b)(2) Defendant(s)/Respondent(s) NOTICE: $35.00 APPLICATION FEE REQUIRED! I, admission to appear and practice in this action on behalf of City and State of Principal Residence: Firm Name: Address: City: Firm/Business Phone: Firm Fax Phone: ( ( ) ) E-mail Address: State: Zip: Suite: , hereby apply to the Court under LRCiv 83.1(b)(2) for pro hac vice . I am admitted to practice before the following courts. (attach additional sheets if necessary) TITLE OF COURT DATE OF ADMISSION IN GOOD STANDING? Yes Yes Yes * Explain: (An Original Certificate of Good Standing from a FEDERAL BAR in which an applicant has been adm itted dated no more than 45 days prior to submission of this application is required.) I have concurrently, or within 1 year of this application, made pro hac vice applications to this Court in the following actions (attach additional sheets if necessary): Case Number Title of Action Date Granted or Denied* No* No* No* * Explain: ALL APPLICANTS ARE REQUIRED TO ANSWER THE FOLLOWING QUESTIONS. If you answer YES to either of the following questions, please explain all circumstances on a separate page. Are you currently the subject of a disciplinary investigation or proceeding by any Bar or Court? Yes Have you ever been disbarred from practice in any Court? Yes No No I declare under penalty of perjury that the foregoing is true and correct; that I am not a resident of, nor am regularly employed, engaged in business, professional I or other activities in the State of Arizona; and that I am not currently suspended, disbarred or subject to disciplinary proceedings in any court. I certify that I have read and will ascribe to the Standards for Professional Conduct, will comply with the Rules of Practice of the United States District Court for the District of Arizona ("Local Rules"), and will subscribe to receive court notices as required by LRCiv 83.1(c). Date Fee Receipt # Signature of Applicant (Rev. 04/12) American LegalNet, Inc. www.FormsWorkFlow.com