(Rev. 3/12/17)UNITED STATES DISTRICT COURTWESTERN DISTRICT OF LOUISIANA INSTRUCTIONS FOR COMPLETING A PETITION FOR ADMISSIONThe attached Petition for Admission must be typewritten or printed legibly.The Clerk should also be furnished with a CURRENT (dated within the last six months),ORIGINAL Certificate of Good Standing from the Clerk of the SUPREME COURT OF THESTATE OF LOUISIANA or the Louisiana Bar Association (must have the Court seal.)The two (2) attorneys that sign your petition MUST be members of the Western District of LouisianaBar. Their signatures must be original. No copied or faxed signatures will be accepted.We also require that you supply us with your Louisiana Bar Number.REMIT a check in the amount of $206.00 with your application. The check should be made payableto 223Clerk, U.S. District Court.224NO APPEARANCE IS NECESSARY OR REQUIRED.If you should have any questions, please contact Stephanie Alvarez, Jury Administrator, at 318-676-4228.In summary, to be admitted, please send:1.Completed Petition for Admission2.Completed 223Written Oath for Admission to Practice2243.Original Certificate of Good Standing from LA Supreme Court or Louisiana BarAssociation4.Admission fee of $206.00toClerk, United States District CourtAttention: Jury Administrator300 Fannin Street, Suite 1167Shreveport, LA 71101 American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 3/12/17) UNITED STATES DISTRICT COURTWESTERN DISTRICT OF LOUISIANAPetition for AdmissionUnder the provisions of Local Rule 83.2.3, the undersigned attorney petitions the Court for admission topractice before this Court representing as follows:Name:(Last)(First)(Middle)Social Security No.XXX-XX-Date of Birth:State Bar ID No. (REQUIRED)Name of Firm:FirmAddress:(Street or P.O. Box)(City)(State)(Zip Code)FirmTelephone:Fax #:(include area code)MY higher educational background is as follows:SCHOOLYEARS (dates)DEGREE In addition to the bar of the Louisiana Supreme Court, I am admitted to practice before thefollowing courts: CourtDate of AdmissionPage 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 3/12/17) I understand that it is my responsibility to advise the Clerk222s Office promptly in writing of any electronicmail or physical address change. I understand that electronic mail filter software (SPAM filter) mayinterfere with receipt of e-mail notices and have verified that any such software installed on my computeror network will not filter out messages sent from Clerk@lawd.uscourts.gov. I understand this electronicnotice will be in lieu of notice by any other means.Primary E-Mail:Secondary E-Mail(s) (e.g., secretaries, paralegal, etc. Do not include co-counsel.):I have never been disbarred nor suspended from practice before any Court, department, bureau,commission, or other body of any state of the United States, nor have I received any reprimand from anysuch Court or other body, except as follows:I am qualified to practice before this Court and am not subject to any pending disbarment or professionaldiscipline procedure in any Court, except as follows:I have read in their entirety the Federal Rules of Civil Procedure, the Federal Rules of CriminalProcedure, the Federal Rules of Evidence, the Code of Professional Responsibility, and the Local Rulesfor the Western District of Louisiana. I will follow and apply such rules before this Court.Signature of ApplicantState ofParish/County of: BEFORE ME, the undersigned Notary Public, came and appeared,who after being duly sworn, did depose and say that all the allegations made in the above Petition for Admission are true and correct to the best of his/her knowledge.Signature of Applicant THUS DONE AND PASSED, before me, Notary Public, thisday of,20, at, Louisiana.Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 3/12/17) Notary PublicENDORSEMENT I am admitted to practice before this Court and am familiar with.I have read the Petition for Admission, and it is true to the best of my knowledge and belief. Petitioner is of good moral character and is qualified to practice before this Court.ENDORSEMENTS MUST CONTAIN ORIGINAL SIGNATURES (NO FAX OR COPY)Signed:Signed:Name:Name:(Type or Print)(Type or Print)DateLA BarDateLA Bar***NOTICE***Effective January 1, 2008, it became mandatory to file by electronic means in the U. S.District Court, Western District of Louisiana. If you need more information about electronicfiling, please refer to our website at www.lawd.uscourts.gov. Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 3/12/17) UNITED STATES DISTRICT COURTWESTERN DISTRICT OF LOUISIANAWRITTEN OATH FOR ADMISSION TO PRACTICE I DO SOLEMNLY SWEAR (OR AFFIRM) that I will support the Constitution of the UnitedStates; that I will well and faithfully discharge my duties as attorney and officer of this Court; and thatI will demean myself uprightly and according to law and the recognized standards of ethics of the legalprofession. I do further solemnly swear (or affirm) that I have read the Federal Rules of Civil Procedure,the Federal Rules of Criminal Procedure, the Federal Rules of Evidence, and the Local Rules of theUnited States District Court for the Western District of Louisiana and that I am fully prepared to use andabide by them in my practice before this Court. SO HELP ME GOD.Signature of ApplicantSTATE OF, PARISH/COUNTY OF: Before me, the undersigned authority, personally came and appeared,to me personally known, who, being by me first duly sworn, did depose and say that the above andforegoing answers and statements were made by him or her and that they are true and correct. Sworn to and subscribed before me, this theday of, 20.Notary PublicPage 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com