UNITED STATES DISTRICT COURT District of Minnesota Request to Practice by Special Permission for U.S. Government Attorneys (Admission Fee Not Applicable) Effective October 5, 2015 226 In addition to emailing this form to the ecf helpdesk, the proposed admittee must also apply for 223Federal Attorney224 admission through his or her PACER account. Under Local Rule 83.5, U.S. government attorneys may practice in the U.S. District Court, District of Minnesota by (1) becoming a member of the court222s bar; (2) being admitted pro hac vice in a specific matter(s); or (3) requesting to practice by special permission. Use this form to request to practice in this court by special permission under LR 83.5(a). This form is intended for use only by U.S. Government Attorneys who will represent the U.S. Government in the District of Minnesota over a period of time in multiple cases. If granted, this special permission to practice in the District of Minnesota is only valid as long as you are employed by the U.S. Government. If you wish to continue to practice in the District of Minnesota after your separation from employment with the U.S. Government, you must become a member of the Court222s bar by following the procedures outlined in LR 83.5(b) and (c). Please note that you are not a member of the bar of this court when you obtain the court222s special permission to practice. To complete this form, the attorney requesting the court222s special permission to practice must complete Section A, and the requesting attorney222s supervisor must complete Section B. A. Requesting Attorney222s Information and Certification I, , request the United States District Court for the District of Minnesota permit me to practice in this court by special permission. In accordance with request, I submit the following information: Residence and Office Addresses Residential Address: Office Name: Address: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 Phone: () Phone: () Fax: () E-mail: All Federal and State Courts, including the attorney license number(s), in which Requesting Attorney is admitted Certification of Requesting Attorney I, , the undersigned, do hereby certify that: The information provided above to support my request to practice by specialpermission is true and correct and that I am a member in good standing of all thecourts to which I am admitted identified above.I have read and am familiar with the Federal Rules of Civil Procedure, theFederal Rules of Criminal Procedure, the Federal Rules of Evidence, and theLocal Rules of the Court, including the Electronic Case Filing Procedures.I understand that the United States District Court for the District of Minnesota isan electronic court and I service under Fed. R. Civ. P. 77(d)by electronic means.I understand that electronic service will be in lieu of service by mail. Date: Signature: B.Certification of Requesting Attorney222s Supervisor I, , hereby certify that the attorney identified above is employed as an attorney by the United States government agency identified above. Date: Signature: Title: U.S. Agency: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 E-mail this completed form to ecfhelpdesk@mnd.uscourts.gov with a subject line of:Attention: Special Permission 226 U.S. Government Attorney PLEASE NOTE IN ADDITION to emailing this completed form to the elpdesk, the government attorney seeking special permission to practice MUST also apply for 223Federal Attorney224 admission to the District of Minnesota through his or her individual upgraded PACER ACCOUNT. For detailed step by step instructions, click here. For questions, please email the elpdesk at ecfhelpdesk@mnd.uscourts.gov or contact an Attorney Admissions Clerk at 651-848-1100. American LegalNet, Inc. www.FormsWorkFlow.com