Free attyqual - Virginia

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA APPLICATION TO QUALIFY AS AN ATTORNEY FOR THE UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF VIRGINIA

PERSONAL STATEMENT
[Full name of Applicant--PLEASE PRINT] Full name: _____________________________________________________________________________ [Street/P. O. Box, City, State, Zip] Residence address: ______________________________________________________________________ Firm: _________________________________________________________________________________ [Firm Name] Office address: _________________________________________________________________________ [Street/P. O. Box, City, State, Zip] [Area Code + Phone Number] Office telephone no: ____________________________ Social Security No: _______________________ [Social Security #] [City & State of Birth] [Month, Day and Year] Place of birth: _______________________________________ Date of birth: _______________________ [School(s), Dates Attended & Degree(s) Obtained] Legal education (including degrees): ________________________________________________________ _________________________________________________________ State Bar No: _________________ [Va. State Bar #] [Continuation of Legal Education] [Employer(s), State(s) & Date(s)] Dates and places of practice: ______________________________________________________________ [Continuation of Dates & Places of Practice] ______________________________________________________________________________________ ______________________________________________________________________________________ [Month, Day, Year] I was qualified to practice in the Supreme Court of Virginia on ___________________________________.

I will keep the Court informed of any changes in the above personal information. I have not been reprimanded in any court nor has there been any action in any court pertaining to my conduct or fitness as a member of the bar. I am a member in good standing of the Virginia State Bar and have paid all necessary license fees. I have read the Federal Rules of Civil Procedure, the Federal Rules of Evidence, the Rules of Bankruptcy Procedure and the Local Rules of the United States Bankruptcy Court for the Eastern District of Virginia within the past ninety days. I hereby swear (or affirm) under the penalty of perjury that the foregoing is true and correct. __________________________________________________
[Sign name as it will appear on future pleadings filed with the Court]

ENDORSEMENT We, the undersigned, do certify that we are members of the bar of this Court; are resident practitioners within the Commonwealth of Virginia; we know the applicant personally; the said applicant possesses all of the qualifications for the practice of bankruptcy law; and that we have examined the applicant's personal statement. We affirm that his (her) personal and professional character is good. [Local Rule 2090-1(C)]
[Date Signed] Date: ______________________ [Attorney's Printed Name] Print Name: _______________________________________

Signature:
[Date Signed] Date: ______________________

_______________________________________

[Attorney's Printed Name] Print Name: _______________________________________

Signature:

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[ver. 4/2005]