UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE IN THE MATTER OF THE APPLICATION OF NH BAR # _________________________ (if assigned) ___________________________________ (Print your name above as you wish it to appear in the records of the Court.) Social Security #: ____________________ Date of Birth: ________________________ PETITION FOR ADMISSION TO PRACTICE I hereby petition the United States District Court for the District of New Hampshire for admission to the bar of said court, and in support of my petition I state as follows: Residential Address ____________________________________________________________________ Firm Name/Mailing ____________________________________________________________________ Address ____________________________________________________________________ Office Telephone _______________________ Home Telephone _______________________________ *Email Address _____________________________________________ NOTE: Please be sure to provide a current email address as the Court will confirm receipt of your petition and fee and contact you regarding upcoming admissions ceremonies via email. I was/will be admitted to practice by the New Hampshire Supreme Court on ______________________ and I am/will be an active member in good standing of the New Hampshire Bar. My educational background is: _________________________________________________________________ ________________________________________________________________________________________________ All occasions, if any, on which I have been charged with or convicted of a crime (except for minor traffic violations), censured, suspended, disciplined or disbarred by any court, or been a party to a civil lawsuit as a plaintiff or defendant, are set forth as follows. (State the facts and circumstances therewith and attach additional sheets if necessary). If none, so state. _________________________________________________________________________________________________ _________________________________________________________________________________________________ I have read and am familiar with the Local Rules of the United States District Court for the District of New Hampshire and the Rules of Professional Conduct as adopted by the New Hampshire Supreme Court. I declare under penalty of perjury that the foregoing is true and correct. Signature: ____________________________________ Date: ______________________ OATH ON ADMISSION I do solemnly swear (or affirm) that as an attorney and as a counselor of this court I will conduct myself uprightly and according to law and that I will support the constitution of the United States. Signature: _______________________________ Date: ___________________ NOTE: Please sign BOTH the declaration and the Oath on Admission prior to submitting your petition. USDCNH-24 (Rev 7/2011) (Previous Editions Obsolete) Admission Date: _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com