UNITED STATES DISTRICT COURT WESTERN DISTRICT OF LOUISIANA ___________________ DIVISION __________________________ VERSUS __________________________ CASE NO._________________ JUDGE ___________________ MAGISTRATE ______________ PETITION FOR ADMISSION PRO HAC VICE In accordance with the Uniform Local Rules for the United States District Court, Western District of Louisiana, application is made to be admitted pro hac vice to the bar of this court for the purpose of appearing on behalf of _______________________________________________ in the above described action. • I am ineligible to become a member of this court, but I am a member in good standing of the bar of the United States District Court for the District of ________________ or the bar of the _____________________ court, which is the highest court of such state. • Attached hereto is a certificate of good standing from such court, and payment of the applicable fee of $105.00, made payable to “Clerk, U.S. District Court.” • There have been no disciplinary proceedings or criminal charges instituted against me. • In accordance with the Uniform Local Rules for the United States District Court, Western District of Louisiana, __________________ of the firm of ____________________ is appointed as local counsel. American LegalNet, Inc. www.FormsWorkFlow.com • I authorize the Clerk of Court for the Western District of Louisiana to transmit notice of entries of judgments and orders to me under Fed.R.Civ.P. 77, Fed..Cr. P. 49, LR 5.7.10W. I also agree to receive notice electronically from other parties and the court via electronic mail. I understand that electronic mail filter software (SPAM filter) may interfere with receipt of e-mail notices and have verified that any such software installed on my computer or network will not filter our messages sent from enoticing@lawd.uscourts.gov. I understand this electronic notice will be in lieu of notice by any other means. I understand it is my responsibility to advise the Clerk’s Office promptly in writing of any physical address changes and/or update my electronic mail address within the court’s electronic filing system. Respectfully submitted, ______________________________ Signature of applying attorney ________________________________ Signature of Local Counsel PLEASE TYPE OR PRINT LEGIBLY: LOCAL COUNSEL INFORMATION Name:________________________ Name:__________________________ Firm:_________________________ Firm:___________________________ Address:______________________ Address:________________________ _____________________________ _______________________________ Telephone:____________________ Telephone:______________________ Fax:_________________________ Fax:___________________________ E-mail: ______________________ E-mail: ________________________ Additional e-mail(s): ______________________________ ______________________________ American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that on ___________________, I presented the foregoing Petition for Admission Pro Hac vice to the Clerk of the Court for filing and uploading to the CM/ECF system which will send notification of such filing to the following: ______________________, and I hereby certify that I have mailed by United States Postal Service this filing to the following nonCM/ECF participants: ______________________________________. ______________________________ Name:_________________________ Firm:_________________________ Address:______________________ ______________________________ Telephone:____________________ Fax:__________________________ E-Mail:_______________________ American LegalNet, Inc. www.FormsWorkFlow.com