1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ____________________________, Petitioner, respectfully represents to the Court: (name of petitioner) UNITED STATES DISTRICT COURT DISTRICT OF NEVADA ) ) ) ) Plaintiff(s), ) ) vs. ) ) ) ) ) Defendant(s). ) ____________________________________) Case #_______________________ VERIFIED PETITION FOR PERMISSION TO PRACTICE IN THIS CASE ONLY BY ATTORNEY NOT ADMITTED TO THE BAR OF THIS COURT AND DESIGNATION OF LOCAL COUNSEL FILING FEE IS $250.00 1. That Petitioner is an attorney at law and a member of the law firm of (firm name) _______________________________________________________________________________ with offices at __________________________________________________________________, (street address) ____________________________________, ____________________________, ____________, (city) (state) (zip code) _____________________________, ___________________________________. (area code + telephone number) (Email address) 2. That Petitioner has been retained personally or as a member of the law firm by [client(s)] _______________________________________ to provide legal representation in connection with the above-entitled case now pending before this Court. Rev. 1/15 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 That since _______________________, Petitioner has been and presently is a (date) member in good standing of the bar of the highest Court of the State of ______________________ where Petitioner regularly practices law. Petitioner shall attach a certificate from the state bar or from the clerk of the supreme court or highest admitting court of each state, territory, or insular possession of the United States in which the applicant has been admitted to practice law certifying the applicant's membership therein is in good standing. 4. That Petitioner was admitted to practice before the following United States District (state) 3. Courts, United States Circuit Courts of Appeal, the Supreme Court of the United States and Courts of other States on the dates indicated for each, and that Petitioner is presently a member in good standing of the bars of said Courts. Court Date Admitted Bar Number _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ _________________________________________ _________________ ___________________ 5. That there are or have been no disciplinary proceedings instituted against petitioner, nor any suspension of any license, certificate or privilege to appear before any judicial, regulatory or administrative body, or any resignation or termination in order to avoid disciplinary or disbarment proceedings, except as described in detail below: 2 2 Rev. 1/15 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 6. That Petitioner has never been denied admission to the State Bar of Nevada. (Give particulars if ever denied admission): 7. That Petitioner is a member of good standing in the following Bar Associations. 8. Petitioner has filed application(s) to appear as counsel under Local Rule IA 10-2 during the past three (3) years in the following matters: (State "none" if no applications.) Date of Application Cause Title of Court Administrative Body or Arbitrator Was Application Granted or Denied ___________________ __________________ _________________________ _______________ ___________________ __________________ _________________________ _______________ ___________________ __________________ _________________________ _______________ ___________________ __________________ _________________________ _______________ ___________________ __________________ _________________________ _______________ (If necessary, please attach a statement of additional applications) 9. Petitioner consents to the jurisdiction of the courts and disciplinary boards of the State of Nevada with respect to the law of this state governing the conduct of attorneys to the same extent as a member of the State Bar of Nevada. 10. Petitioner agrees to comply with the standards of professional conduct required of the members of the bar of this court. 11. Petitioner has disclosed in writing to the client that the applicant is not admitted to practice in this jurisdiction and that the client has consented to such representation. 3 3 Rev. 1/15 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 That Petitioner respectfully prays that Petitioner be admitted to practice before this Court FOR THE PURPOSES OF THIS CASE ONLY. ___________________________________________ STATE OF __________________ ) ) COUNTY OF _________________ ) Petitioner's signature _______________________, Petitioner, being first duly sworn, deposes and says: That the foregoing statements are true. ___________________________________________ Subscribed and sworn to before me this Petitioner's signature __________day of_____________________, ____________. _________________________________________________ Notary Public or Clerk of Court DESIGNATION OF RESIDENT ATTORNEY ADMITTED TO THE BAR OF THIS COURT AND CONSENT THERETO. Pursuant to the requirements of the Local Rules of Practice for this Court, the Petitioner believes it to be in the best interests of the client(s) to designate _________________________, Attorney at Law, member of the State of Nevada and previously admitted to practice before the above-entitled Court as associate resident counsel in this action. The address and email address of said designated Nevada counsel is: ______________________________________________________________________________, (street address) (name of local counsel) ____________________________________, ____________________________, ____________, (city) (state) (zip code) _____________________________, ___________________________________. (area code + telephone number) (Email address) 4 4 Rev. 1/15 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5