United States District Court for the Southern District of Georgia (This f orm m ust be typ ed.) N AME:___________________________________________ G EORGIA B AR N UMBER:________________________________ OFFICE ADDRESS:_______________________________ OFFICE TELEPHONE:___________________________________ _________________________________________________ _________________________________________________ OFFICE F ACSIMILE:_____________________________________ C OUNTY OF R ESIDENCE:________________________________ ---Petition for Bar Admission-P ETITIONER IS A MEMBER IN GOOD STANDING W ITH THE S TATE B AR OF G EORGIA AND HAS PRACTICED THEREIN AS SUCH. P ETITIONER IS ADMITTED TO PRACTICE IN THE FOLLOW ING COURTS: ______________________________________________________________________________________________. H AS P ETITIONER EVER BEEN THE SUBJECT OF ANY OFFICIAL PROCEEDING BROUGHT BY A COURT, LEGAL BAR, GROUP, OR ORGANIZATION THAT THREATENED DISBARMENT, SUSPENSION, SANCTIONS, OR ANY OTHER TYPE OF DISCIPLINE, REGARDLESS OF THE RESOLUTION? _________ IF SO, ATTACH HERETO A FULL EXPLANATION AND CITATION OF THE PROCEEDING. P ETITIONER HAS READ, IS FAMILIAR W ITH, AND PLEDGES COMPLIANCE W ITH THE LOCAL RULES AND THE STANDARDS FOR ATTORNEY CONDUCT OF THIS COURT. P ETITIONER HEREBY REQUESTS ADMISSION TO PRACTICE AS AN ATTORNE Y, SOLICITOR, AND COUNSELOR AT LAW IN THE U NITED S TATES D ISTRICT C OURT FOR THE S OUTHERN D ISTRICT OF G EORGIA. PETITIONER CERTIFIES UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND CORRECT. ________________________________________ (SIGNATURE) T HE UNDERSIGNED MEMBERS OF THE B AR OF THE S OUTHERN D ISTRICT OF G EORGIA DO HEREBY CERTIFY THAT THE FACTS SET FORTH IN THE FOREGOING PETITION ARE TRUE AND THAT P ETITIONER IS AN ETHICAL PERSON OF GOOD MORAL CHARACTER, GOOD CONDUCT, AND PROFESSIONAL RESPONSIBI LITY. D ATED THIS _______ DAY OF ________________, 20_____. _____________________________________ Signature Typed name GA. BAR NO. _______________________________________________________ ______________________________________ Sign ature T yp ed N am e GA. BAR NO. __________________________________________________________ **************************************************************************************************************** T HE FOREGOING PETITION HAVING BEEN CONSIDERED, IT IS O RDERED THAT THE P ETITIONER BE ADMITTED TO PLEAD AND PRACTICE IN THIS C OURT AS AN A TTORNEY, S OLICITOR, AND P ROCTOR UPON TAKING THE PRESCRIBED OATH OF A TTORNEYS, PAYING THE C LERK THE REQUIRED FEE, AND SIGNING THE ROLL. T HIS _______ DAY OF ________________, 20_____. _________________________________ UNITED STATES DISTRICT JUDGE American LegalNet, Inc. www.FormsWorkFlow.com