Free Application for Special Admission - Pro Hac Vice - Oregon

UNITED STATES DISTRICT COURT DISTRICT OF OREGON

Plaintiff(s), vs. Case No: APPLICATION FOR SPECIAL ADMISSION - PRO HAC VICE Defendant(s).

As local counsel in the above captioned case and in accordance with LR 83.3, I am recommending the following attorney for admission pro hac vice: 1. Pro Hac Vice Attorney Certification: I have read and understand the requirements of LR 83.3, and certify that the following information is correct: (A) Personal Data: (1) (2) (3) (4) (5) (6) (B) Name: Firm or Business Affiliation: Mailing Address, City, State and Zip Code: Business E-mail Address: Business Telephone Number: Fax Telephone Number:

Bar Admissions Information: I certify that I am now a member in good standing of the following State and/or Federal Bar Association: (1) State Bar Admissions: Name of court; admissions standing, date of admission, and BAR ID number. Federal Bar Admissions: Name of court; admissions standing, date of admission, and BAR ID number.

(2)

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Application for Sp ecial Admission - Pro Hac Vice Page 1

(C)

Certification of Disciplinary Proceedings: 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; or, I certify that I am now, or have been subject, to disciplinary action from a state or federal bar association or administrative agency. (Attach a letter of explanation to this application.)

(D)

Certification of Professional Liability Insurance: I have a professional liability insurance policy which is current and will apply in this case, and that policy will remain in effect during the course of these proceedings. Representation Statement: I am representing the following party(s) in this case: _______________________________________________________ CM/ECF Registration: Concurrent with approval of this pro hac vice application, I acknowledge that I will automatically be registered to access the court's Case Management/Electronic Case File system. (See ecf.ord.uscourts.gov). I consent to electronic service pursuant to Fed. R. Civ. P 5(b)(2)(D) and LR 100.2(c)

(E)

(F)

2.

Certification of Associated Local Counsel: I certify the information contained in this application is true, that I am member in good standing of the Bar of this Court, that I have read and understand the requirements of LR 83.3, and that I will serve as designated local counsel in this particular case.

DATED this

day of

, 200

.

(Signature of Local Counsel) Typed Name and Oregon State Bar ID Number Firm or Business Affiliation Mailing Address, City, State & Zip Code Business E-mail Address Business Telephone Number

(Signature of Pro Hac Counsel) Typed Name Firm or Business Affiliation Mailing Address, City, State & Zip Code Business E-mail Address Business Telephone Number

Revised M ay 17, 2006

Application for Sp ecial Admission - Pro Hac Vice Page 2

COURT ACTION Application approved subject to payment of fees Application approved and fee waived Application denied

Date

United States District Judge

cc: Counsel of Record

Revised M ay 17, 2006

Application for Sp ecial Admission - Pro Hac Vice Page 3