IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS ____________________________________, Plaintiff(s) Case No. __________________ (All required information must be typed or legibly printed.) Vs. ____________________________________, Defendant(s) APPLICATION FOR ADMISSION OF COUNSEL PRO HAC VICE I, ______________________________, pursuant to Supreme Court Rule 707 and Local Court Rule 3.01(A) of the Local Rules of the Third Judicial Circuit, hereby request permission to appear and participate as an attorney at law in the above entitled cause, on behalf of ____________________________________________________, a party in this cause. In support of this application, being first duly sworn on oath and under penalty of perjury, I state as follows: 1. My name is ________________________________________, and I was born on ________________________________ at ________________________________. All other names that I have ever used or been known by are: _________________________ __________________________________________________________________________. 2. I am a licensed attorney and counselor at law in good standing in the State of ______________________, where I most regularly practice law. My attorney registration number in that State is ____________________. 3. I am a member of the following bar associations: __________________________ __________________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkflow.com 4. In addition, I am licensed to practice law in the State(s) of ________________ ________________________________________, and am admitted to practice before the following federal courts ___________________________________________________. 5. I have never taken the Illinois bar examination nor have I applied for reciprocity in the State of Illinois, or I have taken but did not pass the Illinois bar examination in _________________ (year(s)), or my request for reciprocity was denied in __________________(year(s)). 6. I have never been licensed to practice law in the State of Illinois, or I was licensed to practice law in the State of Illinois from ___________ to ____________, but am no longer licensed to practice law in the State of Illinois. The reason that I am no longer licensed to practice law in the State of Illinois is that: ________________________________________________________________________ ________________________________________________________________________ 7. I was first admitted to the practice of law in the State of __________________ on ________________________(date), and I have practiced law for _________ years. If there is any period of time the applicant did not practice law since his / her first admission to practice, explain the circumstances here: _________________________________________________ ___________________________________________________________________________ 8. I have made the following pro hac vice applications to the courts of the State of Illinois. (List all applications to any court of the State of Illinois listing the most recent application first.) (Attach additional pages if necessary to fully answer this question.) 2 American LegalNet, Inc. www.FormsWorkflow.com Date County Case Number Case Title ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ With respect to every application where leave to appear was denied, the applicant must attach a copy of the Order that was entered denying such application. If the applicant was ever denied leave to appear pro hac vice in any other State, the applicant must also attach a copy of the Order that was entered denying such application. 9. Has any other attorney in your law firm been previously admitted to practice in the courts of the State of Illinois on a Motion to appear pro hac vice? ________ If your answer is yes, provide the following information for each such attorney: _____________________________(name) has made the following pro hac vice applications to the courts of the State of Illinois. (List all applications to any court of the State of Illinois listing the most recent application first.) (Attach additional pages if necessary to fully answer this question.) Date County Case Number Case Title ___________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ With respect to every application where leave to appear was denied to the other attorney, the applicant must attach a copy of the Order that was entered denying such application. If the other attorney was ever denied leave to appear pro hac vice in any other State, the applicant must also attach a copy of the Order that was entered denying such application. 10. I have never been censured, sanctioned, suspended or disbarred by any State, or The following disciplinary proceedings have been instituted against me: (List all disciplinary actions in any court, listing the most recent action first.) (Attach additional pages if necessary to fully answer this question.) 3 American LegalNet, Inc. www.FormsWorkflow.com Date Case number Jurisdiction Allegations Outcome ____________________________________________________________________________ ____________________________________________________________________________ 11. Have you ever been sanctioned or held in contempt by any Judge, agency or other Tribunal other than as set forth in paragraph 10 hereinabove? ___________ If your answer is yes, list all sanctions or findings of contempt, listing the most recent action first.) Applicant must attach a copy of any written Order entered in such proceedings which entered a sanction or found the applicant to be in contempt of court. Date Case number Jurisdiction Allegations Outcome ____________________________________________________________________________ ____________________________________________________________________________ 12. ___________________________(name) __________________________________ _____________(address),_______________(phone number)___________ (Illinois registration number), an attorney licensed in the State of Illinois, has been retained as local attorney to file the Motion for Leave to Appear Pro Hac Vice to which this application is attached. 13. I have read, am familiar with, and will abide by, the Illinois Code of Civil Procedure, Illinois Supreme Court Rules, and Local Rules of the Third Judicial Circuit. In particular, I have read and am familiar with Supreme Court Rule 137 concerning sanctions and agree to be bound by the Illinois Rules of Professional Conduct for attorneys. 14. Applicant must provide the following information regarding a Judge before whom Applicant regularly appears who has agreed to act as a reference concerning applicant’s legal knowledge and ability, character, and professionalism: Name: _______________________________________ Court: _______________________________________ Address: ______________________________________________________ Phone number: _______________________ 4 American LegalNet, Inc. www.FormsWorkflow.com 15. Applicant agrees to immediately notify the Court and all counsel of record in the event any information provided in this application changes or becomes inaccurate. 16. Applicant authorizes the Administrator of any attorney registration and disciplinary commission to disclose to the Presiding Judge in this cause all information contained in the files of such commission concerning his or her current status, any complaints that have been made, and the disposition thereof. Applicant expressly waives any right to confidentiality of any such information that may be required by any Supreme Court Rule and/or by any other statute, rule or regulation providing for confidentiality by such commission. ****************** Name of Applicant: Firm name, if any: Business address: Telephone: Signature: The Applicant, personally known to me, appeared before me this date and affirmed on penalty of perjury that all the contents hereof are complete, true and accurate. Subscribed and sworn to before me this ________ day of ______________, ________, a Notary Public in and for the State of _____________________. Notary Public Commission Expiration Date 5 American LegalNet, Inc. www.FormsWorkflow.com IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS _______________________, et al; ) ) ) ) ) ) ) ) ) Plaintiff, vs. _______________________, et al; Defendant. Case No. __________________ ORDER Motion for Leave to Appear “pro hac vice” allowed. The Court having noted that defendant ______________________ is represented by more than one attorney, it is hereby ordered that attorney _______________________ is designated as lead counsel for the said defendant. Service on lead counsel of notices and copies of pleadings directed to the defendant represented by that attorney is sufficient and need not be made on other attorneys for the same defendant. Further, if directed by the Court, lead counsel shall be responsible for sending notice to co-counsel and opposing counsel of hearings to be held on motions filed by lead counsel or co-counsel. Clerk to send copies of this order to the attorneys of record. Date: ____________________________ ____________________________________ Presiding Judge 1 American LegalNet, Inc. www.FormsWorkflow.com