Fill and Sign the Wiatt V State Farm Insurance Companies 560 F Supp 2d Form

United States District Court Petition for Admission to Practice District of New Mexico (Must be typed) SF-001 - Rev. 12/2016 U.S. District Court, District of New Mexico – Petition for Admission to Practice Page 1 Pursuant to D.N.M.LR-Civ. 83.2, admission to the bar of this court is limited to persons licensed by the highest court of a state, federal territory or the District of Columbia; who are on active status in at least one state, federal territory, or the District of Columbia; and who are in good standing in all courts and jurisdictions where admitted. First Name: Middle Name/Initial: Last Name: ☐ I am employed by the Federal Government. Firm Name: Firm Mailing Address: City: State: Zip: Phone: Firm: Direct: Fax: Email: NM State Bar Number: (If not an NM Bar Member, indicate Not Applicable “N/A”) List all other licensing jurisdictions where you were admitted by examination or by reciprocity. Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Please complete Attachment I to list any additional licensing jurisdictions where you are admitted by examination or by reciprocity. You must attach and submit a current certificate of good standing for each jurisdiction listed. United States District Court Petition for Admission to Practice District of New Mexico (Must be typed) SF-001 - Rev. 12/2016 U.S. District Court, District of New Mexico – Petition for Admission to Practice Page 2 ☐ I certify I am an attorney and meet all the eligibility requirements to be a member of the Court’s bar. ☐ I certify I am in good standing in all attorney licensing jurisdictions or courts to which I have been admitted. ☐ I consent to this Court’s exercise of disciplinary jurisdiction over me in connection with this application and any misconduct related to my practice before the bar of this Court. ☐ I certify that I have read and am familiar with the local rules of this court and that I will comply with all its provisions. ☐ I acknowledge that, if admitted to the bar of this court, I am duty bound to give immediate written notice to the clerk of this court of any formal discipline imposed upon me, including dates and terms thereof, by any court or attorney licensing agency. ☐ I solemnly swear that as an attorney and counselor of this court, I will conduct myself in a professional and ethical manner at all times and that I will support the Constitution of the United States. ☐ I certify that in my practice as an attorney I have never been disciplined; OR, if disciplined, I have provided a full explanation of the circumstances surrounding the discipline in Attachment II (Disciplinary actions, charges and convictions). ☐ I certify that I have not been convicted of a felony, or have any felony charges pending against me; OR; if so, I have provided a full explanation of the circumstances surrounding the charges or conviction in Attachment II (Disciplinary actions, charges and convictions). ☐ Pursuant to 28 U.S.C §1746, I declare under penalty of perjury that the foregoing, and all included attachments, are true and correct. __________________________________________ _________________ Signature of Petitioner Date Submit form and attachments to: U.S. District Court, Clerk's Office You may also submit, via email, a pdf Attention: Attorney Admissions version of the signed document to: 333 Lomas Blvd NW, Suite 270, Albuquerque, NM, 87102 attorneyadmissions@nmcourt.fed.us *Upon admission, you will be notified, via email, regarding payment options for your admissions dues ($181.00). United States District Court Petition for Admission to Practice District of New Mexico (Must be typed) SF-001 - Rev. 12/2016 U.S. District Court, District of New Mexico – Petition for Admission to Practice Page 3 ATTACHMENT I (Additional Jurisdictions): Please list any additional licensing jurisdictions where you were admitted by examination or by reciprocity. Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : Admitted to the bar in: Bar Number: On (MM/DD/YYYY) : NOTE: You must attach and submit a current certificate of good standing for each jurisdiction listed. United States District Court Petition for Admission to Practice District of New Mexico (Must be typed) SF-001 - Rev. 12/2016 U.S. District Court, District of New Mexico – Petition for Admission to Practice Page 4 ATTACHMENT II (Disciplinary actions, charges and convictions): Please give detailed responses below: 1. Have you ever been convicted of a felony, or have any felony charges pending against you? (Please attach all relevant charging and judgment documents with your submission). 2 . Have you ever had an investigation initiated against you alleging unprofessional conduct of any kind or any complaint charging unethical professional conduct filed against you by or with any official committee representing attorneys or courts in New Mexico or elsewhere? (Please attach all official disciplinary documents, orders, or judgments and resolution documents with your submission.)