OEDKy 419A (Rev. 10/08) Application for Admission to Practice in this Court UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY The Application of: (Name to Appear on Certificate) (Mailing Address to Send Certificate) for Admission to Practice in this Court. I hereby apply for admission to practice before the United States District Court for the Eastern District of Kentucky. I ask that my application and accompanying motion be considered and acted upon by any District Judge. I represent that I am an attorney of good moral and professional character and eligible for admission to the Bar of this Court. I have completed training for mandatory electronic case filing through G the Kentucky Bar Association CLE course G on-line tutorial G authorized class room training or G other method (Please explain: _________________________________________________________________________________________________ ________________________________________________________________________________________________). I have been admitted to practice before the following courts (Please include bar membership numbers): _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ I am a member in good standing in the bar of the above courts. I have not have been disbarred, suspended, or disciplined in any fashion from practice in any court or any bar association in any jurisdiction. (If there is any exception, check here G and attach a detailed explanation together with copies of any opinions, order or letters of discipline.) I was born on __________________________at ________________________________________________ If not a citizen of the United States by birth, check here G and state date and place of naturalization: ____________________________________________________________________________________________ _____ Other Information : Home Address: __________________________________________ __________________________________________ Home Telephone No._________________________ Office Address: ______________________________________________ ______________________________________________ ______________________________________________ Office Telephone No._____________________________ State of County of ) _____________________________________ ) )_____________________________________ I, _______________________________________________, do solemnly swear that I will demean myself as an attorney and counselor of this Court, uprightly and according to law; and that I will support the Constitution of the United States. I do further swear that the statements in the foregoing application are true. _______________________________________________ (Signature of Applicant) Subscribed and sworn to before me this ______day of _______________________________, 2_______. Notary Public ________________________________________________ (Signature of Notary Public) State at Large My commission expires: ______________________________ American LegalNet, Inc. www.FormsWorkFlow.com