UNITED STATES BANKRUPTCY COURT DISTRICT OF ARIZONA In Re Chapter Case No. Adversary No.: Debtor(s) Movant/Plaintiff(s) v. APPLICATION FOR LIMITED ADMISSION Respondent/Defendant(s) Applicant, ______________________________, hereby applies for leave to appear and participate in this action. I am a member in good standing of the Bar of the United States District Court for the ___________________ District of _________________, and the Supreme Court of the State of ___________________; I have been retained by_________________________________ _____________________________________ to appear in this court in this action; I am not a member of the bar of the United States District Court, District of Arizona. I declare under penalty of perjury that I: (1) do not reside in Arizona; (2) am not regularly employed in Arizona; and (3) am not regularly engaged in the practice of law in Arizona. American LegalNet, Inc. www.FormsWorkFlow.com I further declare under penalty of perjury that I have filed the following Application(s) for Limited Admission or Pro Hac Vice Application(s) with this court. CASE NAME CASE NUMBER DATE APPLICATION FILED GRANTED DENIED I hereby designate ______________________________, a member of the bar of this court who maintains an office in this district and who has consented to this designation, as cocounsel with whom the court and opposing counsel may readily communicate regarding the conduct of the case. DATED: ____________________ _____________________________ Signature of Attorney _____________________________ Name of Attorney _____________________________ Address _____________________________ State Zip American LegalNet, Inc. www.FormsWorkFlow.com CONSENT TO DESIGNATION I hereby consent to the foregoing designation as a member of the Bar of the United States District Court for the District of Arizona. Dated: ______________________ _____________________________ Signature of Attorney _____________________________ Name of Attorney _____________________________ Address _____________________________ State Zip NOTE: There is no fee required for the filing or granting of this application. American LegalNet, Inc. www.FormsWorkFlow.com