(Rev. 2/06/19) NOTE: The motion and affidavit shall be accompanied by payment of a registration fee in the sum of $50.00. Payment of this fee will be accomplished by credit card payment during the filing of the motion in CM/ECF utilizing the pay.gov system. Attorneys employed by any department or agency of the United States government shall not be required to pay a pro hac vice registration fee. Each attorney requesting admission pro hac vice must complete and sign an Electronic Filing Registration Form. It must be filed as an attachment to the motion. The CM/ECF Electronic Filing Registration Form is available on the Court222s website at www.ksd.uscourts.gov under Forms. American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 2/06/19) IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS , ) ) Plaintiff(s), ) CIVIL ACTION ) CASE NO. ) v. ) ) , ) ) Defendant(s). ) MOTION FOR LEAVE TO APPEAR PRO HAC VICE Pursuant to D. Kan. Rule 83.5.4., I move that be admitted to practice in the United States District Court for the District of Kansas, for purposes of this case only. I certify that I am a member in good standing of the Bar of this Court and that in compliance with D. Kan. Rule 83.5.4(c), I will sign all pleadings and other papers which are signed and filed by said attorney. I also agree that I will participate meaningfully in the preparation and trial of this case, to the extent required by the Court. Pursuant to D. Kan. Rule 83.5.4 (a), I have attached the required affidavit in support of this motion. American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 2/06/19) IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS , ) ) Plaintiff(s), ) CIVIL ACTION ) CASE NO. v. ) ) , ) ) Defendant(s). ) AFFIDAVIT IN SUPPORT OF MOTION FOR LEAVE TO APPEAR PRO HAC VICE Pursuant to D. Kan. Rule 83.5.4., I declare that the following facts are true, to the best of my knowledge, information and belief: 1.My full name is:2.I practice under the following firm name or letterhead:Name:Address: Telephone Number: Fax: Email address: American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 2/06/19) 3.I have been admitted to practice in the following courts (here list the dates and placesof admission to all bars, state or federal, and any bar registration numbers): Court Date of Admission Bar Number 4.I have reviewed D. Kan. Rule 83.5.4. Pursuant to that rule I have retained localcounsel to assist in the representation in this case, and I agree that local counsel willsign all pleadings or other papers and participate meaningfully in the preparation andtrial of the case or proceedings to the extent required by the Court.5.I consent to the exercise of disciplinary jurisdiction over any alleged misconduct thatoccurs during the progress of this case.6.I am in good standing in all bars of which I am a member.7.No disciplinary or grievance proceedings have been previously filed against me.8.No disciplinary or grievance proceedings are pending against me in any jurisdiction.9.I have not been charged in any court of the United States or of any state, territory orpossession of the United States with the commission of a felony or unprofessionalconduct. American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 2/06/19) 10.I have completed the Electronic Filing Registration Form for filing as an attachmentto this motion and affidavit. I understand I will receive System-generated notices ofelectronic filing.[NOTE: To the extent that the applicant cannot truthfully affirm the statements contained in paragraphs 6 through 9, the applicant shall attach additional pages which state all relevant facts in connection with that matter. At a minimum, if disciplinary or grievance proceedings have been filed, or criminal proceedings have been commenced, the applicant shall identify the court, case name, docket number and disposition.] [Affidavit must be notarized and/or contain a declaration that it is being signed under penalty of perjury in accordance with 28 U.S.C. 247 1746 and served in accordance with D.Kan. Rule 5.1] American LegalNet, Inc. www.FormsWorkFlow.com