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Rule 31.25 — Form 2 : Application for Admission Pro Hac Vice --Iowa Supreme Court January 201 7 Rule 31.25 —Form 2 Page 1 of 4 In the Iowa Supreme Court Plaintiff (s) Full name: first, middle, last vs. Defendant (s) Full name: first, middle, last Case no . Application for Admission Pro Hac Vice --Iowa Supreme Court Iowa Court Rule 31.14 1. Application The undersigned seeks permission to appear pro hac vice in the above -captioned proceeding. Applicant shall complete all of the following: Did the applicant seek admission pro hac vice in the proceedings below?  Yes  No If yes, attach copies of all related documents. a. Applicant's full name, residential address, email address, and business address. Full name: f irst, middle, last Email address Mailing address City State ZIP code Business address City State ZIP code b. The name, address, and phone number of each client sought to be represented. c. The courts before which the applicant has been admitted to practice and the respective periods of admission and any jurisdiction in which the out -of -state lawyer has been licensed to practice as a foreign legal consultant and the respective period of licensure. d. Has the applicant ever been denied admission pro hac vice in this state?  Yes  No If yes, on a separate page specify the caption of the proceedings, the date of the denial, and what findings were made. Attach copies of all related documents. e. Has the applicant ever had admission pro hac vice revoked in this state?  Yes  No Rule 31.25 —Form 2 : Application for Admission Pro Hac Vice --Iowa S upreme Court , continued January 201 7 Rule 31.25 —Form 2 Page 2 of 4 If yes, on a separate page specify the caption of the proceedings, the date of the denial, and what findings were made. Attach copies of all related documents. f. Ha s the applicant ever been denied admission in any jurisdiction for reasons other than failure of a bar examination?  Yes  No If yes, on a separate page specify the caption of the proceedings, the date of the denial, and what findings were made. Att ach copies of all related documents. g. Has the applicant ever been formally disciplined or sanctioned by any court in this state?  Yes  No If yes, on a separate page specify the nature of the allegations, the name of the authority bringing such proceedings, the caption of the proceedings, the date filed, what findings were made, and what action was taken in connection with those proceedings. Attach copies of all related documents. h. Has the applicant ever been the subject of any injunction, cea se -and -desist letter, or other action arising from a finding that the applicant engaged in the unauthorized practice of law in this state or elsewhere?  Yes  No If yes, on a separate page specify the nature of the allegations, the name of the author ity bringing such proceedings, the caption of the proceedings, the date filed, what findings were made, and what action was taken in connection with those proceedings. Attach copies of all related documents. i. Has any formal, written disciplinary proceed ing ever been brought against the applicant by a disciplinary authority or unauthorized practice of law commission in any other jurisdiction within the last five years?  Yes  No If yes, on a separate page specify as to each such proceeding: the natur e of the allegations, the name of the person or authority bringing such proceedings, the date the proceedings were initiated and finally concluded, the style of the proceedings, and the findings made and actions taken in connection with those proceedings . Attach copies of all related documents. j. Has the applicant ever been placed on probation by a disciplinary authority in any other jurisdiction?  Yes  No If yes, on a separate page specify the jurisdiction, caption of the proceedings, the terms o f the probation, and what findings were made. Attach copies of all related documents. k. Has the applicant ever been held formally in contempt or otherwise sanctioned by any court in a written order in the last five years for disobedience to the court’s rules or orders?  Yes  No If yes, on a separate page specify the nature of the allegations, the name of the court before which such proceedings were conducted, the date of the contempt order or sanction, the caption of the proceedings, and the substa nce of the court's ru lings. Attach to this application a copy of the written order or a transcript of the oral ruling and other related documents. l. Has the applicant filed an application to appear pro hac vice in this state within the preceding two years?  Yes  No If yes, on a separate page list the name and address of each court or agency and a full identification of each proceeding in which an application was filed, including the date and outcome of the application. Attach copies of all related documents. m. The applicant acknowledge s familiarity with the ru les of professional conduct, the disciplinary procedures of this state, the standards f or professional conduct, the applicable local rul es, and the procedures of the court before which the applicant seek s to practice.  Yes  No Rule 31.25 —Form 2 : Application for Admission Pro Hac Vice --Iowa S upreme Court , continued January 201 7 Rule 31.25 —Form 2 Page 3 of 4 n. List the name, address, telephone number, and personal identification number of an in-state lawyer in good standing of the bar of this state who will sponsor the applicant's pro hac vice request. Lawyer’s name PIN Email address Lawyer’s address City State ZIP code o. The applicant acknowledge s that service upon the in -state lawyer in all matters connected with the proceedings will have the same effect as if personally made upon the applicant .  Yes  No p. If the applicant h as appeared pro hac vice in this state in five proceedings within the preceding two years, the applicant must , on a separate page, provide a statement showing good cause why the applicant shou ld be admitted in the present proceeding. q. On a separate attached page , the applicant must provide any other information the applicant deems necessary to support the application for admission pro hac vice. r. Has the applicant registered with the office of professional regulation and paid the fee as required by Iowa Court Rule 31.14(11) within five years of the date of this application?  Yes  No 2. Oath and Signature I, , have read this Application, and I certify under Print your name penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. , 20 Signed on: Month Day Year Your signature* Mailing address City State ZIP code ( ) Tele phone number Email address Additional email address, if applicable *If fili ng in paper, you must handwrite your si gnature on this form. If fili ng electro nically, you may handwrite your signature on the form, s can the form, and then file it electronically, or, you may affix a digitized signature and file the form el ectro nicall y. Certificate of Service on next page Rule 31.25 —Form 2 : Application for Admission Pro Hac Vice --Iowa S upreme Court , continued January 201 7 Rule 31.25 —Form 2 Page 4 of 4 Certificate of Service The undersigned certifies a copy of this application was served on the following parties on the day of , 20 Month Year by  Personal delivery  Deposit in the U.S. mail Signature of server