UNITED STATES COURT OF APPEALS
FOR THE D.C. CIRCUIT 333 Constitution Avenue, NW, Room 5523 Washington, DC 20001-2866 PHONE 202-216-7000 FAX 202-219-8530
Certificate of Good Standing Request Form
A certificate of good standing may be requested in writing by letter or submitting this completed form to the address above along with the certification fee of $15.00 each. Please make check payable to "Clerk, US Court of Appeals". Or you may request the certificate in person at the address above between the hours of 9:00 a.m. to 4:00 p.m. weekdays. Please provide the name of the attorney who wishes the certificate and the address to which the certificate is to be mailed.
____________________________________ ____________________________________ ____________________________________ ____________________________________
Date of Admittance: ______________________________
_____ I have enclosed a check/money order in the amount of $15.00. Check/Money Order No. ______
USCA Form 49 (12/21/2000) Rev. 7/2007