Application For Special Admission Pro Hac Vice And Order Thereon {120}

UNITED STATES BANKRUPTCY COURT DISTR ICT OF OREGONIn re: ) ) Case No: ) ) APPLICATION FOR SPECIAL ) ADMISSION PRO HAC VICE,Debtor(s) ) AND ORDER THER EON ) ) Adv. Proc. No. (if applicable): Plaintiff ) v. ) ) ) Defendant ) The undersigned, attorney for the following named party(s): , moves for admission of the following attorney pro hac vice:(a) APP LICA NT ATTORNEY INFORMATION (1) Personal Data: (A) Attorneys Name: (B) Firm or Business Affiliation: (C) Mailing Address, City, State and Zip Code: (D) Business Telephone Number: (E) Fax Telephone Number: (2) Bar Admissi ons Informa tion: I certify that I am now a member in good standing of the following State and/or Federal Bar Association: (A) S tate Bar Admissions, Standing, Admissions Date and BAR ID Number: (B) Federal Bar Admissions, Standing, Admissions Date and BAR ID Number:120 (11/10/03) Page 1 of 2 *** SEE NEXT PAGE ***<<<<<<<<<********>>>>>>>>>>>>> 2 (3) Certification of Disciplinary Procee dings : I certify that I am not now, nor have I ever been subject to any disciplinary action by any State or Federal bar association or administrative agency. I certify that I am now, or have been subject to disciplinary action from a State or Federal bar ass ociation or administrative agency (see attached letter of explanation). (4) Certification of Professional Liability Insurance: I certify that I have a current professional liability insurance policy that will apply in this case, and that the policy will remain in effect during the course of these proceedings. (b) CERTIFIC ATION OF ASSOCIA TED LOCAL COUNSEL : I certify that I am a member in good standing of the Bar of this court, and that I will serve as designated local counsel in this particular case: (1) Local Counsels Personal Data : (A) Name and Oregon State Bar ID Number: (B) Firm or Business Affiliation: (C) Mailing Address, City, State and Zip Code: (D) Business Telephone Number: (E) Fax Telephone Number: (2) Meaningful Participation Requirements : I certify that I have discussed the participation requirements of LR 83.3(d) with my associate counsel. (c) SIGNATURES OF COUNSEL Local Counsel Special Admissions Applicant NAME: NAME: ADDRESS : ADDRESS : PHONE: PHONE: ORDER R EGARDING APPLICA TION Application Approved Application Denied U.S. Bankruptcy Judge ### 120 (11/10/03) Page 2 of 2