UNITED STATES DISTRICT COURT DISTRICT OF MAINE IN THE MATTER OF THE APPLICATION OF: (Enter your name above as you wish it to appear in the records of the Court) APPLICATION FOR ADMISSION TO PRACTICE I hereby petition for admission to practice as an attorney and counselor in the United States District Court for the District of Maine. I certify that I was admitted to practice by the Maine Supreme Judicial Court on ; that I am an active member in good standing of the Bar of the State of Maine, Bar No. _______; and that I have read and will comply with the Local Rules of the United States District Court for the District of Maine. Date: (signature) Residence Address: Firm Name/Address: Law School/Location: All Other Bar Admissions:______________________________________________________________ Email: Telephone: Applicant admitted to the U. S. District Court on: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com