UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI ____________DIVISION In re DEBTOR NAME ) ) ) ) Case No. ___- _______- ______ Chapter ___ Debtor(s). VERIFIED MOTION FOR ADMISSION PRO HAC VICE Pursuant to L.R. 2090(B)(1) of the United States Bankruptcy Court for the Eastern District of Missouri, and Rule 12.01(F) of the local rules of the United States District Court for the Eastern District of Missouri, I, move to be admitted pro hac vice to the bar of this Court for the purpose of representing in the instant matter. In support of this motion, I submit the following information as required by Rule 12.01(F): a. b. c. d. e. f. g. Full name of the movant-attorney; Address and telephone number of the movant-attorney; Name of the firm or letterhead under which the movant practices; Name of the law school(s) movant attended and the date(s) of graduation therefrom; State and federal bars of which the movant is a member, with dates of admission and registration numbers, if any; Statement that movant is a member in good standing of all bars of which movant is a member and that movant is not under suspension or disbarment from any bar; Statement that movant does not reside in the Eastern District of Missouri, is not regularly employed in this District, and is not regularly engaged in the practice of law in this District. Movant attests under penalty of perjury to the truth and accuracy of the foregoing facts, and respectfully requests that this motion be granted and that movant be admitted pro hac vice to the bar of this Court and be allowed to appear in the instant matter. Signature of Applicant (See L.R. 9011) (L.F. 7 Rev. 02/2013) American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Service (See L.R. 9004 (D) and L.R. 2090(B)(1)) Name (L.F. 7 Rev. 02/2013) American LegalNet, Inc. www.FormsWorkFlow.com