USDC/ATTY-001 (Rev. 03/11) | LR Civ P 83.6 or LR Cr P 44.6 Statement of Visiting Attorney and Designation of Local Counsel UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF WEST VIRGINIA AT SELECT ONE: STATEMENT OF VISITING ATTORNEY AND DESIGNATION OF LOCAL COUNSEL V. CASE Name of Visiting Attorney and firm name NUMBER ____________________________ Bar ID number Name of party represented ____________________________________________________________________________________________ Name and address of the Bar(s) of which the Visiting Attorney is a member in good standing ____________________________________________________________________________________________ Visiting Attorney’s office address _______________________________________ ______________________ Visiting Attorney’s office telephone number Office fax number ____________________________ Email address WV Name of Sponsoring Attorney and firm name WV Bar ID number ____________________________________________________________________________________________ Sponsoring Attorney’s office address _______________________________________ ______________________ Sponsoring Attorney’s office telephone number Office fax number ____________________________ Email address Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com USDC/ATTY-001 (Rev. 03/11) | LR Civ P 83.6 or LR Cr P 44.6 Statement of Visiting Attorney and Designation of Local Counsel VISITING ATTORNEY’S CERTIFICATION I hereby certify that I am a member in good standing of the Bar(s) listed in the Statement of Visiting Attorney and that I have never been convicted of a felony. I further certify that I have paid the West Virginia State Bar its prescribed pro hac vice fee for this case, and complied with the West Virginia State Bar’s requirements for attorneys admitted pro hac vice. ___________________________ Date ___________________________________________ Signature of Visiting Attorney SPONSORING ATTORNEY’S CERTIFICATION I hereby certify that I am admitted to practice before the Supreme Court of Appeals of West Virginia, I am a member in good standing of the West Virginia State Bar, and I am a member of the bar of this Court. I further certify that I have an office for the practice of law in West Virginia, and I practice law primarily in West Virginia. I agree that pleadings, notices, and other papers may be served on me in this case. I consent to being the Sponsoring Attorney for the above-named Visiting Attorney and I shall hereafter sign all papers that require the signature of an attorney. __________________________ Date __________________________________________ Signature of Sponsoring Attorney ** ELECTRONIC FILING REQUIREMENT ** Electronic filing is required in the United States District Court for the Southern District of West Virginia. Please refer to the Court's website at www.wvsd.uscourts.gov under CM/ECF Information > Electronic Filing > Administrative Procedures for Electronic Case Filing in the SDWV for guidance. Specific requirements regarding logins and passwords and the registration process may be found at Section 6. Login and Password; Registration. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com