UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF LOUISIANA (Local Form 8) APPLICATION FOR LIMITED USE/CLAIM PASSWORD FOR ELECTRONIC CASE FILING SYSTEM NAME: ADDRESS: CITY: ____________________________STATE: _____________ZIP CODE: ____________ PHONE #: FAX #: E-MAIL ADDRESS: BAR ID # (if applicable): 1. 2. 3. STATE OF Pro Hac Vice Application: I affirm that I am admitted to practice in the United States Courts for the ____________ District of ____________ and that the information above is true and correct. Claims or Other Limited Use Application: I affirm that I am authorized to prepare and , and/or am file Proofs of Claim on behalf of authorized to prepare and file Application(s) To Withdraw Unclaimed Funds on behalf of , and/or I am authorized to prepare and file Notice(s) of Appearance on behalf of , and/or that I am authorized to prepare and file Proof(s) of Claim and to appear on behalf of , a child support creditor, and/or am authorized to execute and submit Reaffirmation Agreements on behalf of ________________________. I understand that use of my Limited Use password to file a document in the record of a bankruptcy case or proceeding will constitute my signature upon and my signing of any declarations, affidavits, verifications, proofs of claim, applications to withdraw unclaimed funds, notices of appearance, assignments of claims, reaffirmation agreements, or proofs of claim or other papers involving a child support creditor, or other papers or documents filed American LegalNet, Inc. www.FormsWorkflow.com 4. 5. 6. 7. 8. by use of the password obtained pursuant to this Application, for all purposes authorized and required by law, including, without limitation, the United States Code, Federal Rules of Civil Procedure, Federal Rules of Bankruptcy Procedure, Federal Rules of Criminal Procedure and any applicable non-bankruptcy law. I understand that it is my responsibility to maintain in my records all documents bearing my original signature that are filed using my password, and all documents bearing the original signature of any signer on whose behalf I file the documents using my password, for a period of five years after the case or proceeding in which the papers are filed has been closed. I understand that it is my responsibility to protect and secure the confidentiality of my password. If I believe that my password has been compromised, it is my responsibility to notify the court in writing, immediately. I understand that it is my responsibility to notify the court, immediately, of any change in my address, telephone number, fax number, or e-mail address. I agree to comply with court procedures for the Electronic Case Filing System. I understand that it is my responsibility to learn and use any and all updates to the electronic case filing procedures. I consent to accept service via electronic means from the Court and any other party and I further waive service by other means, including without limitation first class United States Mail. Applicant Signature Date DATE: APPROVED BY: __________________________ LOGIN: PASSWORD: American LegalNet, Inc. www.FormsWorkflow.com