Free Application for Admission to the Bar Pursuant to Local Rule 83.3(c)(2) ~ Northern District of Ohio Members and 83.3(c)(3) ~ Atto - Ohio

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO
APPLICATION FOR ADMISSION TO THE BAR
PURSUANT TO LOCAL RULE 83.3 (c)(2) ~ NORTHERN DISTRICT OF OHIO MEMBERS and 83.3(c)(3) ~ATTORNEYS FOR THE UNITED STATES OF AMERICA WHO ARE AUTHORIZED BY STATUTE TO APPEAR IN ALL FEDERAL COURTS

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NAME ___________________________________________ COUNTY ___________ OHIO SUPREME COURT (OR OTHER COURT) REGISTRATION NO: ___________ BUSINESS ADDRESS _______________________________________________ _______________________________________________ _______________________________________________

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BUSINESS PHONE ____________________ FAX ____________________

5) ALTERNATE ADDRESS _______________________________________________ _______________________________________________ 6) 7) ALTERNATE PHONE(S) _______________________ ______________________

E-MAIL ADDRESS _______________________________________________

8) ADMISSION DATE TO NORTHERN DISTRICT OF OHIO (OR OTHER APPLICABLE COURT) _________________ 9) HAVE YOU EVER CHANGED YOUR NAME OR BEEN KNOWN BY ANY OTHER NAME OR SURNAME, OTHER THAN WHAT APPEARS ON THIS APPLICATION? YES_______ NO_______ 10) IF YES TO 9, GIVE NAME(S) AND PROVIDE DETAILS ______________________ _______________________________________________________________________ 11) HAVE YOU EVER BEEN DISBARRED OR SUSPENDED FROM PRACTICE BEFORE ANY COURT, DEPARTMENT, BUREAU OR COMMISSION OF ANY STATE OR THE UNITED STATES, OR HAVE YOU RECEIVED ANY REPRIMAND FROM ANY COURT, DEPARTMENT BUREAU OR COMMISSION PERTAINING TO YOUR CONDUCT OR FITNESS AS A MEMBER OF THE BAR? YES_______NO _______ 12) IF YES TO 11, PROVIDE DETAILS (ATTACH SEPARATE DOCUMENT AS NECESSARY) _________________________________________________________

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· PLEASE INCLUDE PAYMENT ($200) MAKE CHECKS PAYABLE: CLERK, U.S. DISTRICT COURT (NO FEE REQUIRED FOR ATTORNEYS APPLYING UNDER 83.3(c)(3))*
· ADDRESS TO: "ATTORNEY ADMISSIONS CLERK" Office of the Clerk 260 Joseph P. Kinneary Courthouse 85 Marconi Boulevard Columbus, Ohio 43215

*Please attach a certificate of good standing from the Northern District of Ohio or Other Applicable Court
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PLEASE BE ADVISED that ELECTRONIC FILING is mandatory in the Southern District of Ohio. Unless you note otherwise below, a LOGIN ID and PASSWORD will be provided to you shortly after you are admitted to practice with our Court. This will enable you to file electronically. _________________________________________________________________________________________

CERTIFICATION OF APPLICANT I certify that I have read the foregoing twelve questions and have provided my answers fully and frankly. I further certify that my answers are complete and truthful to the best of my knowledge. _______________________________________ ____________________ _ (signature of applicant) (date) -----------------------------------------------------------------------------------------------------------

IT IS ORDERED that the applicant, being duly sworn according to law and the rule of this Court, is admitted to practice before this Court.

_______________ DATE

______________________________________ DISTRICT JUDGE / MAGISTRATE JUDGE

FEE PAID _______ CERTIFICATE ISSUED _______ ENTERED _______

SDO FORM# 07-83.3 (c)(2)&(3)