Free Application for Special Admission to Practice - Florida

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA SPECIAL ADMISSION ATTORNEY CERTIFICATION
This attorney certification form and the information contained herein neither replaces nor supplements the filing and service of pleadings, motions, or other papers as required by law, rule, or court order. This form is required for use by the Clerk of Court in furtherance of the Guidelines and Plan Administration of Non-Appropriated Funds as adopted by this Court and this form will not be handled as a pleading, motion, or other paper filed in a case before the Court.

Plaintiff(s)/Petitioner(s),

v.

CASE NO:

,
Defendant(s)/Respondent(s)

/ I, of hereby submit this attorney certification form to the Court on behalf .

ATTORNEY INFORMATION
Firm Name: Address: City: Firm/Business Phone: Firm/Business Fax: E-mail Address: State: Zip:

-

-

@

Alternate Phone:

ATTORNEY CERTIFICATION
I certify that: 1. 2. 3. 4. To my knowledge there are NO disciplinary or suspension proceedings pending against me in any Court of the United States or of any State, Territory, or Possession of the United States. NOTE: If proceedings ARE pending at this time, please explain on the reverse side of this form. I am not a resident of the State of Florida. I do not make frequent or regular appearances in separate cases to such a degree as to constitute the maintenance of a regular practice of law in the State of Florida. Within the twelve (12) month period preceding the date of this attorney certification, I have read the most current version of the Local Rules of the United States District Court for the Middle District of Florida.

I declare under penalty of perjury that the foregoing is true and correct.
(mm/dd/yy)
Signature PHV Attorney Certification/Revised 06/24/04 Date Page 1 of 2

CASE MANAGEMENT / ELECTRONIC CASE FILING (CM/ECF)
To obtain a login and password necessary to participate in the Middle District of Florida's Case Management / Electronic Case Filing (CM/ECF) system, please check our web page at www.flmd.uscourts.gov.

ATTORNEY SPECIAL ADMISSION FEE Attorneys specially admitted to practice in the Middle District of Florida under the conditions prescribed in Rule 2.02 of the Local Rules of the United States District Court for the Middle District of Florida, or Rule 2.0901(c)(1) of the Local Bankruptcy Rules for the Middle District of Florida, are required to pay to the Clerk a fee of $10.00 per case. The special admission fee is due with this attorney certification. Payment should be in U.S. currency and checks must be drawn on a U.S. bank. Please make checks payable to "Clerk, U.S. District Court." Providing the Court with an attorney certification form and the $10.00 Special Admission Fee, DOES NOT satisfy the requirements of Rule 2.02, Local Rules for the Middle District of Florida.

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PHV Attorney Certification/Revised 06/24/04

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