Name and address:UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIAPlaintiff(s),v.Defendant(s),CASE NUMBERAPPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE PRO HAC VICE INSTRUCTIONS FOR APPLICANTS (1) The attorney seeking to appear pro hac vice must complete Section I of this Application, personally sign, in ink, the certification in Section II, and have the designated Local Counsel sign in Section III. ELECTRONIC SIGNATURES ARE NOT ACCEPTED. Space to supplement responses is provided in Section IV. The applicant must also attach a Certificate of Good Standing (issued within the last 30 days) from every state bar to which he or she is admitted; failure to do so will be grounds for denying the Application. Scan the completed Application with its original ink signature, together with any attachment(s), to a single Portable Document Format (PDF) file. (2) Have the designated Local Counsel file the Application electronically using the Court's CM/ECF System ("Motions and Related Filings => Applications/Ex Parte Applications/Motions/Petitions/Requests => Appear Pro Hac Vice (G-64)"), attach a Proposed Order (using Form G-64 ORDER, available from the Court's website), and pay the required $400 fee online at the time of filing (using a credit card). The fee is required for each case in which the applicant files an Application. Failure to pay the fee at the time of filing will be grounds for denying the Application. Out-of-state federal government attorneys are not required to pay the $400 fee. (Certain attorneys for the United States are also exempt from the requirement of applying for pro hac vice status. See L.R. 83-2.1.4.) A copy of the G-64 ORDER in Word or WordPerfect format must be emailed to the generic chambers email address. L.R. 5-4.4.2. Applicant's Name (Last Name, First Name & Middle Initial) check here if federal government attorney SECTION I - INFORMATION Firm/Agency Name Street Address Telephone Number Fax Number City, State, Zip Code E-mail AddressI have been retained to represent the following parties: Plaintiff(s) Defendant(s) Other: Name(s) of Party(ies) Represented Plaintiff(s) Defendant(s) Other: List all state and federal courts (including appellate courts) to which the applicant has been admitted, and provide the current status of his or her membership. Use Section IV if more room is needed, or to provide additional information. Name of Court Date of Admission Active Member in Good Standing? (if not, please explain) G-64 (11/18) APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE PRO HAC VICE Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com List all cases in which the applicant has applied to this Court for pro hac vice status in the previous three years (continue in Section IV if needed): Case Number Title of Action Date of Application Granted / Denied? If any pro hac vice applications submitted within the past three (3) years have been denied by the Court, please explain: Has the applicant previously registered as a CM/ECF user in the Central District of California? Yes NoIf yes, was the applicant's CM/ECF User account associated with the e-mail address provided above? Yes No Previous E-mail Used (if applicable)Attorneys must be registered for the Court's Case Management/Electronic Case Filing ("CM/ECF") System to be admitted to practice pro hacvice in this Court. Submission of this Application will constitute your registration (or re-registration) as a CM/ECF User. If the Court signs an Order granting your Application, you will either be issued a new CM/ECF login and password, or the existing account you identified above will be associated with your case. SECTION II - CERTIFICATION I declare under penalty of perjury that: (1) All of the above information is true and correct. (2) I am not a resident of the State of California. I am not regularly employed in, or engaged in substantial business, professional, or other activities in the State of California. (3) I am not currently suspended from and have never been disbarred from practice in any court. (4) I am familiar with the Court's Local Civil and Criminal Rules, the Federal Rules of Civil and Criminal Procedure, and the Federal Rules of Evidence. (5) I designate the attorney listed in Section III below, who is a member in good standing of the Bar of this Court and maintains an office in the Central District of California for the practice of law, as local counsel pursuant to Local Rule 83-2.1.3.4.G-64 (11/18) APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE PRO HAC VICE Page 2 of 3 Dated Applicant's Name (please type or print) Applicant's Signature American LegalNet, Inc. www.FormsWorkFlow.com SECTION III - DESIGNATION OF LOCAL COUNSEL Designee's Name (Last Name, First Name & Middle Initial) Firm/Agency Name Street Address Telephone Number Fax Number City, State, Zip Code E-mail Address Designee's California State Bar NumberI hereby consent to the foregoing designation as local counsel, and declare under penalty of perjury that I maintain an office in the Central District of California for the practice of law. Dated Designee's Name (please type or print) SECTION IV - SUPPLEMENT ANSWERS HERE (ATTACH ADDITIONAL PAGES IF NECESSARY)G-64 (11/18) APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE PRO HAC VICE Page 3 of 3 Designee's Signature American LegalNet, Inc. www.FormsWorkFlow.com