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UNITED STATES DISTRICT COURT
District of Minnesota

APPLICATION FOR PRO SE LITIGANT TO FILE ELECTRONICALLY
Pursuant to Fed. R. Civ. P. 5(e) and Local Rule 5.1, electronic case filing is authorized in the District of Minnesota and implemented by Court Order. Electronic case filing is governed by the standards and procedures set forth in the most recent version of the "Electronic Case Filing Procedures for the District of Minnesota," which may be found on the Court's website at www.mnd.uscourts.gov. The Court's Electronic Case Filing (ECF) system is for use only in cases designated by the U.S. District Court for the District of Minnesota and may only be used to file electronic documents. In order to file electronic documents through ECF, pro se litigants must submit this application. Only pro se litigants who have a matter pending before the U.S. District Court for the District of Minnesota and are not prohibited from filing electronically in this Court may apply to file electronically on ECF. The Court reserves the right to add or remove conditions to this application. Upon review and approval of the application, a login and password will be issued to the applicant. Thereafter, the applicant will have privileges to electronically file documents with the Court and to receive electronic service of filings in their cases. Pro Se Litigant Information and Certification First/Middle/Last Name: Street Address: ______________________________________________________ ______________________________________________________

City/State/Zip Code: ______________________________________________________ Daytime Phone Number: E-mail Address: (_____)_______________________ _____________________________ __________________________________________

Pending Case Number(s) in this Court:

By signing below, I certify that the information provided above is true and correct.

Date: ______________

Signature: ________________________________

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Pro Se Litigant Consent Should my Application for Pro Se Litigant to File Electronically be approved, I, _________________________________________, the undersigned pro se litigant agree and consent to the following: 1. To abide by the Federal Rules of Civil Procedure, the Federal Rules of Criminal Procedure, and the Local Rules for the United States District Court for the District of Minnesota. 2. I understand that the provisions of Local Rule 5.1, "Electronic Case Filing," the "Order Adopting Electronic Case Filing Procedures" signed by the Court on May 17, 2004, and the most recent version of the Court's Civil and Criminal ECF Procedures Guides for the District of Minnesota apply to electronic filing in this District and I agree to abide by all provisions set forth therein. 3. I agree that all my transmissions for electronic filings of pleadings and documents to the ECF system shall be titled in accordance with the approved directory of civil and criminal events in the ECF system. 4. I agree that the combination of the user login and password will serve as my signature for purposes of the Federal Rules of Civil and Criminal Procedure. I further agree to protect the security of my password. If I believe it is being used without my permission, I will change my password and will inform the Clerk of Court by telephone of the misuse. 5. I have read and I understand the provisions of Federal Rule of Civil Procedure 11 and I understand that the provisions of Rule 11 apply with full force and effect to documents filed using ECF. 6. I consent to receive service of notice of Court Orders and judgments electronically through the Court's ECF system under Federal Rule of Civil Procedure 77(d) and Federal Rule of Criminal Procedure 49(c), and I thereby agree to waive service of such notice by other means under Federal Rules of Civil Procedure 5(b)(2) and 77(d) and Federal Rule of Criminal Procedure 49(c). 7. I consent to receive electronic service through the Court's ECF system of pleadings and other papers under Federal Rule of Civil Procedure 5, and I thereby agree to waive service by other means under Federal Rule of Civil Procedure 5(b)(2) and Federal Rule of Criminal Procedure 49, unless service by electronic means is not allowed under the Federal Rules of Civil Procedure and Criminal Procedure. 8. I understand that I will receive the initial electronic copy of a document filed at no charge when I am an official recipient of the document (the "free look" provision in ECF). After that, I understand that all remote electronic access to the case file documents occurs

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through the Judiciary's PACER system and that a separate PACER account is required to view electronic documents and docket sheets in ECF. If I obtain a PACER account, I understand that I will be charged an access fee at a per-page rate. I understand I can obtain a PACER account at http://pacer/psco/cgi-bin/register.pl. 9. I understand that I can view electronic documents and docket sheets in person at the four divisional Clerk's Offices in the District of Minnesota at no charge on the public access terminals. 10. I understand that abuse of ECF access privileges will result in revocation of my ECF access. 11. I understand that my ECF access will be deactivated following closure of my pending matter(s) and the expiration of all applicable appeal periods. 12. I agree to update any changes to my contact information, including my e-mail address, using the Utilities tab in ECF. Directions for updating contact information are available on the Court's website at www.mnd.uscourts.gov.

Date: ____________

Signature of Applicant: ________________________________

PLEASE MAIL OR DELIVER THIS APPLICATION TO: Warren E. Burger Federal Building and U.S. Courthouse Attn: Admissions 316 North Robert Street, Suite 100 St. Paul, MN 55101 *The Clerk of Court will not accept this application transmitted electronically or by facsimile. The application must be submitted to the Clerk of Court with the original ink or wet signature.

If you have any questions about this application form or the application process, please contact Admissions at (651) 848-1122.

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