UNITED STATES DISTRICT COURT District of Nebraska APPLICATION FOR ADMISSION TO PRACTICE $150.001 Provide case number if admission requested by court: _____________________ Appearing on behalf of: I, ____________________, do hereby certify that I have been enrolled as a member of the Bar of the Supreme Court of _______________ and I now desire to be enrolled as a member of the Bar of the United States District Court for the District of Nebraska. _ _____________________ ______ (Bar Code if Bar Applicable) ________________________________________ ________________________________________ ________________________________________ ________________________________________ (Law Firm or Federal Agency) (Mailing Address) (City, State, Zip) (Telephone/Fax Number) I, ____________________, being duly sworn on oath say: That as an officer of the United States District Court for the District of Nebraska, I shall demean myself faithfully, uprightly, and according to law; and that I shall support, uphold, and defend the Constitution of the United States of America; so help me God. DATED this ____ day of ____________, 20__. _________________________________________________ (Signature of Applicant) ================================================================================== (This portion must be completed and signed by either the clerk of the highest court in any state in which the applicant is admitted to practice OR by a member of the Bar of the United States District Court for the District of Nebraska). I hereby certify that the applicant is of good moral character and a member of the highest court of the state of __________________ as certified by the applicant above. DATED this ____ day of ______________, 20__. Clerk of the Supreme Court of the State of ______________________________ Member of Bar, U.S. District Court For the District of Nebraska OR _____________________________________ (Please sign name) _____________________________________ (Please print name) _________________________________________ (Please sign name) _________________________________________ (Please print name) NE Bar Code # ____________________________ ================================================================================= IS ORDERED: Applicant is hereby admitted to practice as an attorney and counselor at law in the United States District Court for the District of Nebraska. DATED this ____ day of __________, 20__. __________________________________________________ (Deputy Clerk) Last update 5/25/06 1 n:\proc\forms\attyadm.wpd The $150.00 filing fee is waived for federal agency attorneys. American LegalNet, Inc. www.FormsWorkflow.com