Fill and Sign the Louisvillewestern District of Kentuckyunited States District Form

United States District Court Western District of Kentucky Office of the Clerk United States Courthouse 601 West Broadway, Room 106 Louisville, Kentucky 40202-2249 www.kywd.uscourts.gov (502) 625-3500 V an essa L . A rm str o n g J am es V ilt C le rk o f C ou rt Chie f D ep u ty C le rk IN RE: ADMISSION TO PRACTICE BY WRITTEN MOTION Pursuant to LR 83.1 and LCrR 57.1 of the Joint Local Rules, to seek admission to practice by motion before the Bar of the Court, you must provide the Clerk with this application for admission, your sponsor’s affidavit in support of your applicat ion, and the $211.00 admission fee. Please make your check payable to “Clerk, U.S. District C ourt.” To expedite your ability to electronically file documents with the Court, please also inclu de an ECF Registration form available at http://www.kywd.uscourts.gov/forms/ecf-registration-form . Upon the Court’s acceptance of your application and prepayment of the fee, you w ill be notified by mail that you have been admitted to practice be fore the Western District of Kentucky. The Clerk will mail you a certificate of admission. NAME OF APPLICANT HOME ADDRESS FIRM NAME OFFICE ADDRESS OFFICE TELEPHONE BAR NUMBER DATE OF BIRTH PLACE OF BIRTH UNIVERSITY ATTENDED DEGREE & DATE LAW SCHOOL ATTENDED DEGREE & DATE DATE OF ADMISSION TO SUPREME COURT OF KENTUCKY OTHER STATE AND FEDERAL COURTS IN WHIC H YOU ARE ADMITTED TO PRACTICE AND DATE(S) OF ADMISSION NAME OF SPONSOR SPONSOR’S DATE OF ADMISSION TO THE USDC FOR THE WESTERN DISTR ICT OF KENTUCKY SPONSOR’S TELEPHONE NO. PURSUANT TO JOINT GENE RAL ORDER 08-02, I HAVE COMPLETED MANDATO RY ELECTRONIC CASE FILING TRAINING THROUGH (select one): ☐ Web-Page Tutorial ☐ Court Personnel ☐ KY Bar Association CLE Course ☐ Training in other Jurisdictio n or Other Method (Please Expl ain) FEE PAID : ____________________ D ATE : _____________________ R ECEIPT NUMBER :______________ B Y: _________________________ A DMITTED : ________________ ___ UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY IN RE: ADMISSION OF ATTORNEY TO PRACTICE-SPONSOR’S AFFIDAVIT AND MOTION SPONSOR’S AFFIDAVIT STATE OF________________________ COUNTY OF _______________________ _________________________________________, having been duly sworn, deposes and states as follows: That I was duly admitted to practice before the United States District Court for the Western District of Kentucky on ___________________, and am now a member in good standing of the Bar ofsaid court. That this affidavit is submitted in support of the application of ________________________ for admission to the Bar of the United States District Court for the Western District of Kentucky. That I have read the said application and believe the statements therein to be true and correct. That I vouch for the good moral and professional character of the applicant and that the applicant has been admitted to practice before and is in good standing with the Supreme Court of Kentucky . In my opinion, the applicant is fully qualified to be admitted to practice before the United States District Court for the Western District of Kentucky. Dated at ________________________, this _____ day of _______________________, 19 _____. ______________________________________Signature ______________________________________ Name ______________________________________ Address Subscribed and sworn to before me this _______ day of __________________________, 19 ____. Notary Public _____________________________ My Commission Expires: ____________________ 20 20 SPONSOR’S MOTION ________________________________, sponsor for the aforesaid applicant, hereby moves that ______________________________ be admitted to the Bar of the Unit ed States District Court for the Western District of Kentucky and be permitted to practice before said court as an attorney and counselor-at-law for all proper purposes. The applic ant has requested to be admitted by mail rather than by person appearance in open court. ________________________________ Signature OATH/AFFIRMATION TO BE ADMINISTERED WHEN REQUEST FOR ADMISSION ISPERFECTED BY MAIL: I, _____________________________ do solemnly swear or affirm th at I have been admitted to practice before and am in good standing with the Suprem e Court of Kentucky, that I will conduct myself honorably and ethically as a solicitor, counselor, advoc ate, proctor and attorney of this court, and that I will support and defend the Constitution of the United States. ________________________________ Applicant Signature Subscribed and sworn to/affirmed before me this _____ day of _________________, 20___. ________________________________Notary Public ________________________________ Commission Expiration ORDER Having determined after reviewing the attached affid avit that the applicant is qualified to be admitted, IT IS HEREBY ORDERED the above motion is GRANTED and that the applicant be admitted to practice before the United Stat es District Court for the Western District of Kentucky. Date Judge _____________ _________________________ Date Judge Form 419B -WDKYUnited States District Court WESTERN DISTRICT OF KENTUCKY ______________________________ RE: APPLICATION FOR ADMISSION - AUTHORIZATION AND RELEASE I, _______________________________________________, whose Social Security Number is ______________________, having filed an application for admission to the Bar of this Court consent to have an investigation made as to my moral character, professional reputation and fitness for the practice of law and such information as may be received, reported to the admitting authority. I agree to give any further information which may be required in reference to my pastrecord. I also authorize and request every person, firm, company, corporation, governmental agency, court, association, or institution having control of any documents, records, or other information pertaining to me, to furnish to the Clerk, United States District Court for the Western District of Kentucky any such information, including documents, records, bar association files regarding charges or complaints filed against me, formal or informal, pending or closed, or any other pertinent data, and to permit the said Clerk to inspect and make copies of such documents, records and other information. I hereby release and discharge, the state admission agency of the state(s) of my admission, its agents and representatives, and any person so furnishing information from any and all liability of every nature and kind arising out of the furnishing or inspection of such documents, records, and other information to or by the said Clerk. I have read the foregoing document and have furnished all information fully and frankly. The information is complete and true of my own knowledge. ___________________________________ (Signature of Applicant) Subscribed and sworn to before me this _____________ day of _______________, 2012. ___________________________________ ___________________________________