UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF GEORGIA IN RE: : : : : : : Debtor(s). : _______________________________________: : : : : Plaintiff(s). : : v. : : : : : Defendant(s). : _______________________________________: BANKRUPTCY CASE NO. CHAPTER JUDGE ADVERSARY NO. APPLICATION FOR ADMISSION TO APPEAR PRO HAC VICE I, hac vice on behalf of , hereby request permission to appear pro in the above referenced case. My residence and office addresses and office telephone number are as follows: Residence address: Revised 12/08 American LegalNet, Inc. www.FormsWorkflow.com Office Address: Office Telephone No. The courts to which I am admitted to practice and the dates of admission are as follows: Court Location Date Admitted Bar ID No. I am in good standing and eligible to practice in all courts to which admitted. I am not eligible for admission to the bar of the United States District Court for the Northern District of Georgia and neither reside nor maintain an office for the practice of law within the State of Georgia.. I understand that the information I have provided in this application is subject to verification by Court personnel. I hereby designate the following member of the Bar of this court with whom the court and opposing counsel may readily communicate regarding the conduct of the case and upon whom papers shall be served: . I make the foregoing statements under penalty of perjury. Dated: ______________________________ Applicant Revised 12/08 2 American LegalNet, Inc. www.FormsWorkflow.com Consent To Designation as Local Counsel I, , hereby consent to my designation as counsel in the above- styled case with whom the court and opposing counsel may readily communicate regarding the conduct of the case and upon whom papers shall be served. Dated: ______________________________ Designee Ga. State Bar. No. Address: E-Mail Address (If any): Telephone: Revised 12/08 Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF GEORGIA IN RE: : : : : : : Debtor(s). : _______________________________________: : : : : Plaintiff(s). : : v. : : : : : Defendant(s). : _______________________________________: BANKRUPTCY CASE NO. CHAPTER JUDGE ADVERSARY NO. ORDER OF ADMISSION PRO HAC VICE The court having read the Application of for admission to practice pro hac vice in the above-styled case and it appearing that the Applicant meets the requirements of bankruptcy Local Rule 9010-2, it is ORDERED that the Application is GRANTED. This _____ day of ____________________, ___________. ____________________________________ U. S. BANKRUPTCY JUDGE Revised 12/08 Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com