Application for Admission to the Southern District of Indiana UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF INDIANA IN RE: ) ) ADMISSION TO THE BAR ) Comes now , a member in good standing of the (Please print name of moving party.) bar of this Court, to move for the admission of . (Please print name of applicant.) In support of this motion, the Movant and Applicant state as follows: MOVANT222S SWORN STATEMENTS That the applicant for admission is a person of good personal and professional character; That I have confirmed that the applicant for admission is a licensed attorney currently active and in good standing and admitted to practice in the following state(s): [Movant must confirm applicant222s current license in at least one state.] ; and That I am not currently the subject of any disciplinary sanction, proceeding, or investigation in any jurisdiction. Movant222s Signature and Date: Address and Phone Number: American LegalNet, Inc. www.FormsWorkFlow.com Application for Admission to the Southern District of Indiana APPLICANT222S SWORN STATEMENTS That I have listed below all the states and federal jurisdictions to which I have been admitted to practice and am currently active, and the year of each admission: ; [Attach extra sheet if necessary.] That I am in good standing in all jurisdictions to which I have been admitted; That I am not currently the subject of any disciplinary sanction, proceeding, or investigation in any jurisdiction; That I have read and agree to abide by the Seventh Circuit Standards Of Professional Conduct, pursuant to Local Rule 83-5; That if the motion for my admission is granted by this Court, I will take the prescribed oath or affirmation, pay the required fees, sign the roll of attorneys, and provide my current post office address, pursuant to Local Rule 83-5; That I will register for Electronic Case Filing, pursuant to Local Rule 83-5; and That I agree to notify the clerk promptly of any future name or address changes, pursuant to Local Rule 5-3. Applicant222s Signature and Date: Signature Date Print Name Address, Phone Number, and Email: NOTE: Admission applications will be processed in the order received, and as expeditiously as possible. Please allow five (5) business days for processing. For Office Use Only (Date of Admission) American LegalNet, Inc. www.FormsWorkFlow.com