Fill and Sign the Ludwig Farmslinkedin Form

United States District Court Northern District of Indiana Stephen R. Ludwig, Clerk ATTORNEY ADMISSION APPLICATION ELIGIBILITYAny attorney admitted to practice by the Supreme Court of the United States or the highest court of any state [L.R. 83.5(b)]. P L E A S E R E A D C O M P L E T E L YGENERAL INFORMATIONFee:$60.00 - cash, money order or check (payable to “Clerk, U.S. District Court”). Application:1.An application form follows these instruction. 2.You will need a movant, in good standing, who is a member of the Bar of this Court. The movant will sign and date the form which certifies that you are of good moral character and professional standing. 3.Mail your application and check or money order to: Clerk, U.S. District Court 102 Robert A. Grant Courthouse 204 South Main Street South Bend, IN 46601 4.Your certificate will be sent by mail. Page 1 of 2 Revised 01/31/01 UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF INDIANA APPLICATION FOR ADMISSION TO PRACTICE (Type or Print Very Neatly) Prefix ( ch e ck one): Mr. Ms. Mrs. Last Name: ___________________________ First Name: _______________________ M.I.: ______ Generation (Sr., Jr., etc.): __________ Social Security No.: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ Date of Birth:___________________ Place of Birth (City and State): ____________________________ Firm Name: Street Address: ________________________________________________ Suite Number: _______ City: __________________________ State: ______ Zip: _________________ Zip + 4: __________ Office Telephone No.: _______________ ___________ Fax No.: ______ _________________________ Indiana Atty. Registration #: ____________________ E-mail: _______________________________ EDUCATION : College:________________________ Degree:___________________ Year Completed: __________ Law School:_______________________________________________ Year Graduated: _________ Other Post-Graduate Schooling: ______________________________________________________ Currently Admitted to Practice Before: ____________U.S. Supreme Court ____________Seventh Circuit Court of Appeals ____________Indiana Supreme Court ____________Other Jurisdictions _____________________ APPOINTMENTS UNDER THE CRIMINAL JUSTICE ACT AND THE CIVIL RIGHTS ACT : Are you willing to represent defendants determined to be eligible for representation under the Criminal Justice Act of 1964? __________ Yes __________ No Are you willing to be appointed to represent complainants under the Civil Rights Act of 1964? __________ Yes __________ No Page 2 of 2 Movant:I, , a member in good standing of the bar of this Court hereby certify that the above information is correct to the best of my knowledge and I now personally assure the Court that the Applicant's private and professional character is good and do now move for the admission of ______________________________this _______day of ___________________, 20____. _____________________________ Signature of Movant Applicant:I, , do solemnly swear or affirm that I will support and defend the Constitution of the United States of America against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will demean myself as attorney, proctor and solicitor of the United States District Court for the Northern District of Indiana uprightly and according to law, so help me God. I also state that pursuant to N.D. Ind. L.R. 83.5(b), I have read and will abide by the Local Rules of the United States District Court for the Northern District of Indiana, including Appendix B: Standards for Professional Conduct Within the Seventh Federal Judicial Circuit. I do hereby certify that the statements I have made are true and correct to the best of my knowledge and belief. Signature of Applicant Dated: _____________________________________ SO ORDERED. Date______________________________________________ Judge, U.S. District Court