Fill and Sign the Application of Non Resident Attorney to Appear in a Specific Form

UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA Plaintiff(s) v. Defendant(s).CASE NUMBER APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE NOTICE: Effective November 1, 2011, the fee for Pro Hac Vice Appearance is $325.00 for each case application. Please submit the fee with your application, if you are efiling the application attach a copy of your receipt. Pursuant to Local Rule 83-2.4, submission of this application and th e fee is waived for attorneys for the United States, its departments and agencies with Appointment Affidavits on file with the Clerk. If no Appointment Affidavit is on file, submission of the application is required. The Pro Hac Vice appearance fee must be paid in full before any appearance will be permitted. Proof of paymen t receipt must be attached to this application. A CERTIFICATE OF GOOD STANDING for the applicant from the state in which the applicant is a member of the bar, and which has been issued within 30 days, must be attached to this application. I, , hereby apply to the Court under Local Rules 83-2.3 and 83-2.8.2 for permission to appear and participate in the above-entitled action on behalf of G Plaintiff G Defendant: by whom I have been retained. My business information is: Firm Name Street Address City, State, Zip E-Mail Address Telephone Number Fax Number I am a member in good standing and eligible to practice before the following courts. List all that apply. Attach additional pages if necessary. Title of Court Date of Admission G–64 (11/11)APPLICATION OF NON-RESIDENT ATTO RNEY TO APPEAR IN A SPECIFIC CASE PAGE 1 of 2 Name and address: I am not a resident of the State of California. I am not regularly employed in, or engaged in substantial business, profession al, or other activities in the State of California. I am not curren tly suspended from, and I have never been disbarred from pract ice in any court. I have concurrently, and within three (3) years of this application, made Pro Hac Vice applications to this Court in the following actions. List all that apply. Attach additional pages if necessary. Case Number Ttitle of Action Date of Application Application Granted or Denied If any Pro Hac Vice applications submitted within three (3) years of this application have been denied by the Court, please explain: I designate as local counsel, whose business information is as follows: Firm Name Street Address City, State, Zip E-Mail Address Telephone Number Fax Number who is a member in good standing of the Bar of this Court and ma intains an office in the Central District of California for the practice of law, as the attorney with whom the Court a nd opposing counsel may readily communicate regarding the conduct of this case, and upon whom papers may be served. I declare under penalty of perjury that the foregoing is true and correct and that I am familiar with the Local Rules, the Loca l Criminal Rules, the F.R. Civ. P., the F.R. Crim. P., a nd the F.R. Evidence. I also consent to electronic service. Dated Applicant’s Name (please print) Applicant’s Signature I hereby consent to the foregoing designation as lo cal counsel and I consent to electronic service. Dated Designee’s Name (please print) Designee’s Signature Designee’s California State Bar Number NOTE: COUNSEL AND PARTIES ARE REMINDED TO SUBMIT A COMPLETED ORDER ON APPLICATION OF NON- RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE (G -64 ORDER ) ALONG WITH THIS APPLICATION . G–64 (11/11)APPLICATION OF NON-RESIDENT ATTO RNEY TO APPEAR IN A SPECIFIC CASE PAGE 2 of 2