Application For Admission Pro Hac Vice

UNITED STATES DISTRICT COURT District of Nebraska APPLICATION FOR ADMISSION PRO HAC VICE $100.00 , Plaintiff, Case No: v. Appearing on behalf of: , Defendant. I, , do hereby certify that I have been enrolled as a member of the Bar of the Supreme Court of and I now desire to be enrolled as a member of the Ba r of the United States District Court for the District of Nebraska. (Bar Code or Number, if applicable ) (Law Firm or Federal Agency) (Mailing Address) (City, State, Zip) (Telephone/Fax Number) I, , swear, affirm, or acknowledge that as an officer of the United States D istrict Court for the District of Nebraska, I will demean myself faithfully, uprightly, and according to law; and that I will support, uphold, and defend the Constitution of the United States of America. DATED this day of , 20 . (Signature of Applicant) ( Original signature required when submitted in paper ) ================================================== =================== IT IS ORDERED: Applicant is hereby admitted to practice as an attorney and counselor at law in the United States District Court for the District of Nebraska for this case only. DATED this day of , 20. (Deputy Clerk) Receipt Number COPIES MAILED ON L ast update 0 9/ 29/17 American LegalNet, Inc. www.FormsWorkFlow.com