Format for Pro Hac Vice Motion (Rev. 1/05) IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE ) ) Civil Action No. ) MOTION AND ORDER FOR ADMISSION PRO HAC VICE Pursuant to Local Rule 83.5 and the attached certification, counsel moves the admission pro hac vice of ____________________________________ to represent_______________________ ___ in this matter. Signed:______________________________________________ (Movants Name and Delaware State Bar Identification Number) (Movants Address) (Movants Telephone Number) Attorney for: ________________________________________ Date: ________________________ ORDER GRANTING MOTION IT IS HEREBY ORDERED counsels motion for admission pro hac vice is granted. Date: _________________ ___________________________________________ United States District Judge CERTIFICATION BY COUNSEL TO BE ADMITTED PRO HAC VICE Pursuant to Local Rule 83.5, I certify that I am eligible for admission to this Court, am admitted, practicing and in good standing as a member of the Bar of __________________ and pursuant to Local Rule 83.6 submit to the disciplinary jurisdiction of this Court for any alleged misconduct which occurs in the preparation or course of this action. I also certify that I am generally familiar with this Courts Local Rules. In accordance with Standing Order for District Court Fund effective 1/1/05, I further certify that the annual fee of $25.00 has been paid to the Clerk of Court, or, if not paid previously, the fee payment will be submitted to the Clerks Office upon the filing of this motion. Signed: _______________________________________ Date: ______________________ (Applicants Address) American LegalNet, Inc. www.USCourtForms.com