Fill and Sign the Complete All Questions Indicate Na If Necessary Form

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS § Plaintiff § § § v.§Case No. § § § Defendant § APPLICATION FOR ADMISSION PRO HAC VICE (Complete all questions; indicate “N/A” if necessary.) I. Applicant is an attorney and a member of the law firm of (or practices under the name of) , with offices at (Street Address) (City) (State) (Zip Code) (Telephone No.) (Fax No.) II. Applicant will sign all filings with the name . III. Applicant has been retained personally or as a member of the above-named firm by: (List All Parties Represented) to provide legal representation in connection with the above-styled matter now pending before the United States District Court for the Northern District of Texas. IV.Applicant is a member in good standing of the bar of the highest court of the state of , where Applicant regularly practices law. Bar license number:_______________ Admission date:____________________________ Attach to this application an original certificate o f good standing issued within the past 90 days from t he attorney licensing authority in a state in which yo u are admitted to practice (e.g., State Bar of Texas ). V. Applicant has also been admitted to practice before the following courts: Court: Admission Date: Active or Inactive: VI. Applicant has never involuntarily lost, temporarily or permanently, the right to practice before any court or tribunal, or resigned in lieu of discipline, except as provided below: VII. Applicant has never been subject to grievance proceedings or involuntary removal proceedings— regardless of outcome—while a member of the bar of any state or federal court or tribunal that requires admission to practice, except as provided below: VIII. Applicant has not been charged, arrested, or convicted of a criminal offense or offenses, except as provided below (omit minor traffic offenses): For Court Use Only. Bar StatusVerified: _______________ IX.Applicant has filed for pro hac vice admission in the United States District Court for the Northern District of Texas during the past three (3) years in the following matters: Date of Application: Case No. And Style: (If necessary, attach statement of additional applications.) X. Local counsel of record associated with Applicant in this matter is , who has offices at (Street Address) (City) (State) (Zip Code) (Telephone No.) (Facsimile No.) XI. Check the appropriate box below. For Application in a Civil Case Applicant has read Dondi Properties Corp. v. Commerce Savs. & Loan Ass’n , 121 F.R.D.284 (N.D. Tex. 1988) (en banc), and the local civil rules of this court and will comply with the standards of practice adopted in Dondi and with the local civil rules. For Application in a Criminal Case Applicant has read and will comply with the local criminal rules of this court. XII. Applicant respectfully requests to be admitted to practice in the United States District Court for the Northern District of Texas for this cause only. Applicant certifies that a true and correct copy of this document has been served upon each attorney of record and the original upon the clerk of court, accompanied by a $25.00 filing fee, on this the day of , . Printed Name of Applicant Signature