Fill and Sign the By Petitioner Form

United States District Court for the Northern District of Illinois PETITION FOR ADMISSION TO THE GENERAL BAR 1 PETITIONER’S NAME LAST NAME FIRST NAME MIDDLE NAME/INITIAL 2 IDENTIFICATION NUMBER Enter the number issued by the Illinois Attorney Registration & Disciplinary Commission. If the petitioner was admitted elsewhere, enter both the number issued by an equivalent commission and the corresponding state. NUMBER STATE 3 OTHER NAMES USED BY PETITIONER LAST NAME FIRST NAME MIDDLE NAME/INITIAL LAST NAME FIRST NAME MIDDLE NAME/INITIAL 4 ADDRESS OF PETITIONER’S RESIDENCE STREET ADDRESS CITY COUNTY STATE ZIP 5 ADDRESS OF PETITIONER’S LAW FIRM FIRM OR BUSINESS NAME STREET ADDRESS ROOM CITY COUNTY STATE ZIP 6 DAYTIME PHONE : EMAIL ADDRESS: 7 ADMISSION DATE Enter the date on which the petitioner was admitted to practice before the Illinois Supreme Court or the highest court of another state or the District of Columbia. DATE 8 LAW SCHOOLS ATTENDED BY PETITIONER LAW SCHOOL DEGREE DATE RECEIVED LAW SCHOOL DEGREE DATE RECEIVED 9 Has the petitioner ever been censured, suspended, disbarred or otherwise\ disciplined by any court? YES* NO Has the petitioner ever been, or is the petitioner currently, the subjec\ t of an investigation of the petitioner’s professional conduct? YES* NO Has the petitioner ever been transferred to inactive status, voluntarily\ withdrawn, or resigned from the bar of any court? YES* NO Has the petitioner ever been denied admission to the bar of any court (\ not including a denial resulting from the failure to pass a bar examination)? YES* NO Has the petitioner ever been held in contempt of court? YES*NO *If the answer to ANY of the questions above is yes, please attach a bri\ ef description of the incident(s) and the petitioner’s current stat\ us before any court, or agency thereof, where disciplinary sanctions were i\ mposed, or where an investigation or investigations of the petitioner’\ s conduct may have been instituted. I, the above-named, do hereby petition for admission to the general bar \ of the United States District Court for the Northern District of Illinoi\ s. In support of this petition I state that (a) I have read each of the answ\ ers provided to items 1 through 9 above and they are each true and corre\ ct, (b) I have read and willfaithfully adhere to the Rules of Professional Conduct\ for the United States District Court for the Northern District of Illin\ ois (Local Rules 83.50 through83.58), and (c) I have read and will faithfully ad\ here to the Standards for Professional Conduct within the Seventh Federa\ l Judicial Circuit. I declare under penalty of perjury that the foregoing is true \ and correct. DATE: (Petitioner’s Signature) AFFIDAVIT OF SPONSOR NAME OF SPONSOR LAST NAME FIRST NAME MIDDLE NAME/INITIAL ADDRESS OF SPONSOR FIRM OR BUSINESS NAME STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP ADMISSION DATEEnter the date on which the sponsor was admitted to practice before the Illinois Supreme Court or the highest court of another state or the District of Columbia. DATE STATE I, the above-named sponsor, state that: (a)I am currently, and for at least two years have been, a member in good standing of the general bar of (State or District of Columbia) (b)I have known the petitioner for a period of not less than years. (c)I have known the petitioner under the following circumstances: (d)I know the petitioner’s character to be: (e)I know the petitioner’s reputation to be: (f)I know the petitioner’s experience at the bar to be as follows: (g)The petitioner is of good moral character and otherwise well qualified to practice as a member of the bar of the United States District Court for the Northern District of Illinois. I declare under penalty of perjury that the foregoing is true and correct. DATE: (Signature of Sponsor) AFFIDAVIT OF SPONSOR NAME OF SPONSOR LAST NAME FIRST NAME MIDDLE NAME/INITIAL ADDRESS OF SPONSOR FIRM OR BUSINESS NAME STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP ADMISSION DATEEnter the date on which the sponsor was admitted to practice before the Illinois Supreme Court or the highest court of another state or the District of Columbia. DATE STATE I, the above-named sponsor, state that: (a)I am currently, and for at least two years have been, a member in good standing of the general bar of (State or District of Columbia) (b)I have known the petitioner for a period of not less than years. (c)I have known the petitioner under the following circumstances: (d)I know the petitioner’s character to be: (e)I know the petitioner’s reputation to be: (f)I know the petitioner’s experience at the bar to be as follows: (g)The petitioner is of good moral character and otherwise well qualified to practice as a member of the bar of the United States District Court for the Northern District of Illinois. I declare under penalty of perjury that the foregoing is true and correct. DATE: (Signature of Sponsor) INSTRUCTIONS REGARDING THE SIGNING OF THE OATH OF OFFICE PETITIONER MUST SIGN THE OATH OF OFFICE BEFORE FILING THE PETITION. PURSUANT TO LOCAL RULE 83.10(e), PETITIONERS MAY CHOOSE WHETHER OR NOT TO APPEAR IN PERSON BEFORE A JUDGE TO BE ADMITTED. IF A PETITIONER IN THE EASTERN DIVISION DOES NOT WISH TO APPEAR IN PERSON TO BE SWORN IN, THE PETITIONER’S SIGNATURE BELOW MUST BE NOTARIZED. PETITIONERS IN THE WESTERN DIVISION MUST APPEAR IN PERSON BEFORE A JUDGE IN THAT DIVISION TO BE ADMITTED. OATH OF OFFICE I do solemnly swear (or affirm) that I will defend the Constitution of the United States of America; that I will faithfully discharge my duties as an attorney and counselor; and that I will demean myself uprightly and according to law and the recognized standards of ethics of the profession, so help me God. (Signature) Subscribed and sworn to (or affirmed) before me thisday of,20 Deputy Clerk or Notary Public FOR OFFICIAL USE ONLY(Fee Stamp) Checked by Deputy on DATE OF ADMISSION