Pro Hac Vice Application Form

Jurisdiction(s) (Boxes for State Bar use only.) Atty Status Application Number Discipline Date Received Staff Initials Appearance: Applicant Firm Fee Paid Check No. MT Attorney SBM ODC Date Sent to Court or Agency Revised 1/12 STATE BAR OF MONTANA P.O. Box 577, Helena, MT 59624 Street Address: 33 S. Last Chance Gulch, Suite 1B , Helena, MT 59601 Telephone: (406) 442 - 7660 Fax: (406) 442 - 7763 PRO HAC VICE APPLICATION The original application must be submitted to the State Bar of Montana with a fee of $ 4 9 5 for each pro hac vice appearance requested and a certificate of good standing from each state the attorney is a member of . 1. Phone E - Mail 2. Firm Name (List all firm(s) with which you are associated.) 3. Office Address City State Zip 4 . Residence Address City State Zip 5. List the name, address, and telephon e number of the active member of the Sta te Bar of Montana who is the attorney of record in the case for which this application is being made. Attorney & Firm Name Daytime Phone Number Address City State Zip 6 . List all state and federal courts in which you have been admitted to practice and the dates of admission and provide certification of good standing for each State only . Do not include pro hac vice admissions. A. State Courts: B. Federal Courts: American LegalNet, Inc. www.FormsWorkFlow.com Montana Pro Hac Vice Application Page 2 7. Are you currently suspe nded, disbarred, or otherwise not licensed to practice in any of the above courts? If so, attach copies of all relevant court documents or disciplinary documents. Yes No 8 . Are you subject to pending disciplinary proceedings in any jur isdiction? Yes No If so, attach a description of the nature and status of each pending disciplinary proceeding. 9 . Do you maintain a residen ce in Montana? Yes No 10 . Are you regularly employed in Montana? Yes No 11 . Are you regularly engaged in the practice of law or in substantial business or professional activities in Montana? Yes No 12 . Do you have an application for admission to the State Bar of Montana pending ? Yes No 1 3 . List the title of each state court and cause in Montana in which you OR YOUR FIRM have filed an application to appear as counsel pro hac vice, the date of each application, and whether it was granted or denied . ( Do not list F ederal court pro hac vice a ppearances.) Li st the current title, court , and cause number for which you are applying. Title, Court, Cause # County Date Granted: (Yes, No) A. Previous Cases : B. CURRENT Case: (please include County) 1 4 . I agree to comply with the applicable statutes, laws , and procedural rules of the State of Montana . I further agree to be bound by the Montana Rules of Professional Conduct (except as to Rules 6.1 - 6.4) and will submit to the jurisdiction of the Mont ana courts, the Montana disciplinary process, and the State Bar of Montana with respect to acts and omissions occurring during admission under this application. 15. I understand that a lawyer not admitted to practice in Montana is subject to the disciplinary authority of Montana for conduct that constitutes a violation of the Montana Rules of Professional Conduct and that: a) involves the practice of law in Montana by that lawyer; or b) involves that lawyer holding himself or herself out as practi cing law in Montana; or c) involves the practice of law in Montana by another lawyer over whom this lawyer has the obligation of supervision or control. 1 6 . I state that payment has been made to the State Bar of Montana in accordance with the requirement s of Section IV of the Rules for Admission and in accordance with the requirements of Rule 6 of the Rules for Lawyer Disciplinary Enforcement . 1 7 . I understand I have an on - going obligation to advise the State Bar of Montana and court/administrative agency if my standing or status changes in any of the jurisdictions in which I am admitted during the term of my pro hac vice admission. American LegalNet, Inc. www.FormsWorkFlow.com Montana Pro Hac Vice Application Page 3 18 . or deny this application. ( All applications will be counted as an appearance unless the State Bar of Montana is advised the application was denied by the Court.) 19 . I agree to notify the State Bar of Montana of any appeal s if the case is referred to a higher court . ( I f the abo ve action proceeds to a court of higher jurisdiction, I understand the appealed case will not be counted as an additional appearance. ) 20 . I agree to provide current certificates of good standing from the jurisdiction(s) in which I am admitted. 21. I understand that the $ 3 9 5 assessment i s an annual assessment and agree to promptly pay the assessment as long as this proceeding is pending before a Mont ana administrative agency or any Montana court (except federal court). State of County of The above statements are true based upon knowledge and belief. Further, I agree to submit to the pro hac vice rules, the Montana Rules of Professional Conduct, and the Montana Rules for Lawyer Disciplinary Enforcement . Signature of Applicant Date Subscribed and sworn to (or affirmed) before me this day of , 20 . Notary Signature: Printed Name of Notary: (SEAL) Notary Public for the State of : Residing in: My commission expires: ATTACH: Certificate(s) of Good Standing $4 9 5.00 Pro Hac Vice Fee www.montanabar.org . Please direct questions to soconnor@montanabar .org or (406) 447 - 2204 . American LegalNet, Inc. www.FormsWorkFlow.com