UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIAREQUEST FOR ATTORNEY ADMISSION INFORMATIONName of RequestorAddressTelephone NumberCityI hereby request the following:Certificate of Good Standing (for attorneys currently admitted to the Bar of this Court)Name of AttorneyCA State Bar No.No. of CertificatesFee Per Certificate$19.00 $19.00 $19.00 Duplicate Admission Certificate (may only be requested by the attorney or attorney222s firm)Name of AttorneyCA State Bar No.No. of Certificates$19.00 Original certificate is:(Original certificate must be returned, if available.) Verification of AdmissionName of AttorneyCA State Bar No.Search Fee$31.00Make cashier222s check, certified bank check, business or corporate check, government-issued check, or money order drawn on a major American bank or the United States Postal Service payable to Clerk, U.S. District Court. The Clerk's Office will also accept credit cards (Mastercard/Visa, Discover, American Express) for filing fees and miscellaneous fees. Credit card payments may be made at all payment windows where receipts are issued. PERSONAL CHECKS ARE NOT ACCEPTED.G-63 (05/18) REQUEST FOR ATTORNEY ADMISSION INFORMATION E-mail Address (Required) Lost Damaged Destroyed Name changed Other DateIf you are a registered CM/ECF user in this district, you must submit your request for a Certificate of Good Standing, Certificate Re Search for Grievances, Duplicate Admission Certificate, or Verification of Admission electronically through CM/ECF and pay the required fee by credit card via pay.gov. Do not complete this form. For instructions, go to www.cacd.uscourts.gov/attorneys/attorney-certificates/instructions-requesting-attorney-certificates . If you are not a registered CM/ECF user in this district, mail this completed form and fee to the address indicated below.Certificate Re Search For GrievancesName of AttorneyCA State Bar No.No. of CertificatesFeeN/A N/A N/A Fee Per CertificateMail this completed form and fee to:Attn: Fiscal Section United States District Court Central District of California 255 E. Temple St., Suite TS-134 Los Angeles, CA 90012Note:Requests for a Certificate of Good Standing and for Verification of Admission will be processed and sent to the e-mail address you provided above within three (3) business days of receipt. Requests for duplicate Admission Certificates are processed within four (4) weeks of receipt; please allow an additional three (3) days for mailing. If you do not receive the certificate or verification within that time, e-mail cacdattyadm@cacd.uscourts.gov. StateZip Code American LegalNet, Inc. www.FormsWorkFlow.com