COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : UNITED STATES DISTRICT COURT SUBPOENA JUDICIAL Plaintiff(s) -against- District of Nebraska : ___________________________, Plaintiff, : Case No: ___________________________________ v. : Appearing on behalf of: _______________________ _____ _____ _____ _____ _____ _____ __, Def endan t. Defendant(s) : ...................................................... APPLICATION FOR ADMISSION PRO HAC VICE I, ____________________, do hereby certify that I have been enrolled as a member of the Bar of the Supreme Court of _______________ and I OF desire YORK THE PEOPLE OF THE STATE now NEW to be enrolled as a member of the Bar of the United States District Court for the District of Nebraska. ________________________________________ (Law Firm) _______________________ TO ________________________________________ (Mailing Ad dress) (Bar Code if Bar Applicable) ________________________________________ (City, State, Zip) ________________________________________ (Telephone/Fax Num ber) I, ____________________, being duly sworn on oath say: That as an officer of the United States District Court for GREETINGS: the District o f Nebra ska, I shall de mean myself fa ithfully, up rightly, and accordin g to law; an d that I shall su pport, uphold, and defend the Constitution that all business and excuses being laid aside, you and each of you attend WE COMMAND YOU, of the United States of America; so help me God. before , the Honorable at the Court DATED this ____ day of ____________, 20__. _________________________________________________ located at County of (Signature of Petitioner) in================================================================================== recessed room , on the day of , 20 , at o'clock in the noon, and at any or(This portion must be completed andevidence as a witness in thisthe highest the part of the in which the adjourned date, to testify and give signed by either the clerk of action on court in any state petitioner is admitted to practice OR by a member of the Bar of the United States District Court for the District of Nebraska). I hereby Your failure to comply with goodsubpoena is punishable as a contempt of court and will make you liable to certify that the petitioner is of this moral character and a member of the highest court of the state of __________________ as certified by the petitioner above. DATED this ____ day of ______________, 20__. sustained as a the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages result of your failure to comply. Clerk of the Supreme Court of the State of ______________________________ Witness, Honorable Member of Bar, U.S. District Court For the District of Nebraska OR , one of the Justices of the _____________________________________ Court in County, day of (Please sign name) _____________________________________ (Please print name) _________________________________________ , 20 (Please sign name) _________________________________________ (Please print name) (Attorney must sign above and type name below) NE Bar Code # ____________________________ ================================================================================= Attorney(s) for IS ORDERED : Petitioner is hereby admitted to practice as an attorney and counselor at law in the United States District Court for the District of Nebraska for this case only. DATED this ____ day of __________, 20__. __________________________________________________ (Deputy Clerk) Office and P.O. Address COPIES MAILED ON _______________________________ Last update 2/22/00 n:\proc\forms\attyphv.wpd Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com