FORM 6 (ND/SD MISS. DEC. 2015) UNITED STATES DISTRICT COURT Southern DISTRICT OF MISSISSIPPI Plaintiff v. CIVIL ACTION NO. Defendant APPLICATION FOR ADMISSION PRO HAC VICE (A) Name: Firm Name: Office Address: City: Telephone: E-Mail: State Fax: Zip (B) Client(s): Address: City: Telephone: State Fax: Zip American LegalNet, Inc. www.FormsWorkFlow.com FORM 6 (ND/SD MISS. DEC. 2015) The following information is optional: Have you had a prior or continuing representation in other matters of one or more of the clients you propose to represent, and is there a relationship between those other matter(s) and the proceeding for which you seek admission? Do you have any special experience, expertise, or other factor that you believe makes it particularly desirable that you be permitted to represent the client(s) you propose to represent in this case? (C) I am admitted to practice in the: ______ State of ____________________ District of Columbia and is currently in good standing with that Court. A certificate to that effect, issued by the appropriate licensing authority within ninety days of the date of this Application, is enclosed; the physical address, telephone number and website/email address for that admitting Court are: All other courts before which I have been admitted to practice:: Jurisdiction Period of Admission American LegalNet, Inc. www.FormsWorkFlow.com FORM 6 (ND/SD MISS. DEC. 2015) (D) Have you been denied admission pro hac vice in this state? Have you had admission pro hac vice revoked in this state? Has Applicant been formally disciplined or sanctioned by any court in this state in the last five years? Yes No If the answer was "yes," describe, as to each such proceeding, the nature of the allegations, the name of the person or authority bringing such proceedings; the dates the proceedings were initiated and finally concluded; the style of the proceedings; and the findings made and actions taken in connection with those proceedings: (E) Has any formal, written disciplinary proceeding ever been brought against you by a disciplinary authority in any other jurisdiction within the last five years? Yes No If the answer was "yes," describe, as to each such proceeding, the nature of the allegations; the name of the person or authority bringing such proceedings; the date the proceedings were initiated and finally concluded; the style of the proceedings; and the findings made and actions taken in connection with those proceedings. (F) Have you been formally held in contempt or otherwise sanctioned by any court in a written order in the last five years for disobeying its rules or orders? Yes No American LegalNet, Inc. www.FormsWorkFlow.com FORM 6 (ND/SD MISS. DEC. 2015) If the answer was "yes," describe, as to each such order, the nature of the allegations, the name of the court before which such proceedings were conducted; the date of the contempt order or sanction, the caption of the proceedings, and the substances of the court's rulings (a copy of the written order or transcript of the oral rulings must be attached to the application). (G) Please identify each proceeding in which you have filed an application to proceed pro hac vice in this state within the preceding two years, as follows: Name and Address of Court Date of Application Outcome of Application (H) Please identify each case in which you have appeared as counsel pro hac vice in this state within the immediately preceding twelve months, are presently appearing as counsel pro hac vice, or have pending applications for admission to appear pro hac vice, as follows: Name and Address of Court Style of Case American LegalNet, Inc. www.FormsWorkFlow.com FORM 6 (ND/SD MISS. DEC. 2015) (I) Have you read and become familiar with all of the LOCAL UNIFORM CIVIL RULES OF THE UNITED STATES DISTRICT COURTS FOR THE NORTHERN AND SOUTHERN DISTRICTS OF MISSISSIPPI? Have you read and become familiar with the MISSISSIPPI RULES OF PROFESSIONAL CONDUCT? Yes No (J) Please provide the following information about the resident attorney who has been associated for this case: Name and Bar No: Firm Name: Office Address: City: Telephone: E-Mail: State Fax: Zip (K) The undersigned resident attorney certifies that he/she agrees to the association with Applicant in this matter and to the appearance as attorney of record with Applicant. ___________________________ Resident Attorney I certify that the information provided in this Application is true and correct. Date ___________________________ Applicant's Signature Unless exempted by Local Rule 83.1(d)(5), the application fee established by this Court must be enclosed with this Application. American LegalNet, Inc. www.FormsWorkFlow.com FORM 6 (ND/SD MISS. DEC. 2015) CERTIFICATE OF SERVICE The undersigned Applicant certifies that a copy of this Application for Admission Pro Hac Vice has been mailed or otherwise served on this date on all parties who have appeared in this case. This the _______ day of ______________, 20__. _____________________________ Applicant's Handwritten Signature American LegalNet, Inc. www.FormsWorkFlow.com