COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : APPLICATION FOR MEMBERSHIP IN THE CRIMINAL JUSTICE JUDICIAL SUBPOENA Plaintiff(s) DEFENSE PANEL FOR THE UNITED STATES DISTRICT COURT -against: FOR THE EASTERN DISTRICT OF LOUISIANA : Send completed application for processing to: : Clerk Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .United . . . . . . . . . . .District Court . . . . . . . . States . . Eastern District of Louisiana 500 Poydras Street, Room C-151 New Orleans, Louisiana 70130 THE PEOPLE OF THE STATE OF NEW YORK TO ALL QUESTIONS MUST BE ANSWERED APPLICATION GREETINGS: OF 1. I hereby apply for all business and excuses Criminalaside, you and each of you attend before WE COMMAND YOU, that membership in the being laid Justice Defense Panel for the Eastern District of Louisiana. , the Honorable at the Court located at County of 2. I was admitted to practice law in the State of Louisiana on in room , on the day of , 20 , at o'clock in the noon, and at any recessed and was admitted to practice in the United States or adjourned date, to testify and give evidence as a witness in this action on the part of the District Court for the Eastern District of Louisiana on 3. . I have also been admitted to practice in the following courts: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Name of Court Date Admitted the party on whose behalf this subpoenaLocation for a maximum penalty of $50 and all damages sustained as a was issued result of your failure to comply. Witness, Honorable , one of the Justices of the Court in4. I have County, day of , 20 been engaged in the active practice of criminal law since , and am an active member of the Louisiana State Bar in good standing. (Attorney must sign above and type name below) 5. Have you ever been disciplined by the bar of any state or by any court? . If so explain. Attorney(s) for 6. My courtroom experience within the last five (5) years has been as follows: (Please identify by court, caption, docket number, type of Office and P.O. Address case and date the applicant’s most significant courtroom experience within the preceding five years, giving particular emphasis to criminal proceedings). [Use attached sheets for answer.] Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 7/89 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. 7. My appellate experience within the five(5) years preceding this : JUDICIAL SUBPOENA Plaintiff(s) application is as follows: [Use attached sheets for answer.] -against8. I read understand language(s): : , write , speak: and/or (check as applicable) the following foreign : Defendant(s) : ...................................................... 9. Have you ever been employed as a full-time prosecutor, public . If so, name of defender, or law clerk to a judge or justice? office or judge, and dates of employment: THE PEOPLE OF THE STATE OF NEW YORK TO 10. Do you have any other legal training or experience which would qualify you for membership in the panel? GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 11. During the five years preceding this application, have you located at County of been arrested, summoned, charged or convicted of any criminal offense in room , on the day of , 20 , at o'clock in the noon, and at any recessed (excluding minor traffic infractions)? . If so, explain" or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 12. Are behalf this subpoena was issued for a maximum penalty of $50 and all in the party on whoseyou willing to accept appointment without compensation damages sustained as a cases your failure to comply. result ofnot compensable under the Criminal Justice Act (for example, civil rights actions, etc.)? Yes Witness, Honorable No . , one of the Justices of the 13. Professional references. (please list at least two attorneys Court in County, day of , 20 or judges familiar with applicant’s professional competence): (Attorney must sign above and type name below) I hereby authorize all educational institutions, government Attorney(s) for agencies and instrumentalities (including bar associations and bar examiners of other jurisdictions), employers and business and professional associates (past and present), to release to the Panel Selection Committee of the United Stated District Court for the Eastern Office and P.O. Address District of Louisiana, any non-privileged information, files or records requested by them for the purpose of processing this application. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 7/89 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) Calendar No. : JUDICIAL SUBPOENA -againstI further state that I have carefully read : the foregoing application and certify that the information therein is true, or true to the best of my knowledge and belief. I fully understand that failure to : make a truthful disclosure of any fact or item of information required : my result in the denial of my application, and such other action as the court deems appropriate. Defendant(s) : ...................................................... Executed of at (Date) , Louisiana (City) I declare under the penalty of YORK THE PEOPLE OF THE STATE OF NEWperjury that the foregoing answers and statements are true and correct. TO (Signature of Applicant) GREETINGS: NAME (Type) WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ADDRESS , the Honorable at the Court located at County of CITY & STATE in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the SOCIAL SECURITY NO. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result ofPLEASE TAKE comply. THAT IF THE APPLICANT HAS NOT BEEN NOTIFIED your failure to NOTICE OF APPROVAL OR REJECTION OF HIS/HER APPLICATION (18) MONTHS OF ITS FILING AND THE APPLICANT HAS Witness, Honorable INTEREST IN MEMBERSHIP IN THE PANEL, AN UPDATED Court inBE FILED WITHIN FIFTEEN (15) DAYS FOLLOWING THE County, day of , 20 EIGHTEEN (18) MONTH PERIOD. WITHIN EIGHTEEN A CONTINUING , one of the Justices of the APPLICATION MUST END OF SAID (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 7/89 American LegalNet, Inc. www.USCourtForms.com