UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT 1100 East Main Street, Suite 501 Richmond, Virginia 23219-3517 (804) 916-2700 www.ca4.uscourts.gov CERTIFICATE OF GOOD STANDING REQUEST A Certificate of Good Standing may be requested by mailing the completed form and a check made payable to "Clerk, U.S. Court of Appeals" to the Clerk, U.S. Court of Appeals for the Fourth Circuit, 1100 East Main Street, Suite 501, Richmond, Virginia, 23219. The completed form and payment may also be submitted using the CM/ECF system. To pay fees by credit card, users must register for a Fourth Circuit CM/ECF account. See Pay Fees by Credit Card for more details. Fee amount: $19.00 Attorney Name: ___________________________________________ Admission Date (if known): __________________________________ The certificate should be sent to: Name: Firm: Street/PO Box: City: State: Zip Code: Contact Phone Number: ____________________________ 12/01/2016 DLG American LegalNet, Inc. www.FormsWorkFlow.com