OAL DKT. NO. ________________ AGENCY DKT. NO. ____________ ______________________________, Petitioner, v. ______________________________, Respondent. AFFIDAVIT IN SUPPORT OF MOTION TO APPEAR PRO HAC VICE _______________________________ I, ________________________________, duly sworn according to law, depose and say: 1. I am an attorney in good standing admitted to practice in the _________________________________________________ (name of highest court in state of admission) of__________________________________ (state of admission). My office address is ; My office phone number is . I am not admitted to practice in New Jersey, or I am admitted to practice in New Jersey but I do not maintain a bona fide office for the practice of law in this state. 2. I am associated in this matter with New Jersey counsel of record, ________________________________, who is qualified to practice law in this state, pursuant to R. 1:21-1. The address for New Jersey counsel is ___________________________________________; the phone number is ________________________________________________________________. 3. ________________________________ (client's name) has requested my representation in this matter. 4. I am not now the subject of any pending disciplinary proceedings in any jurisdiction nor have I been disciplined previously in any jurisdiction. If you are or have been the subject of disciplinary proceedings, please state the date, jurisdiction, nature of the ethics violation(s)/charges and the penalty imposed or the likely time of disposition if still pending: ________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _______________________________________________. American LegalNet, Inc. www.FormsWorkFlow.com 5. There is good cause for my admission pro hac vice in that _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ________________________________________________ 6. I have paid to the New Jersey Lawyers' Fund for Client Protection and Ethics Financial Committee the fees required by R. 1:28-2 and 1:20-1(b). 7. If this application to appear pro hac vice is granted, I agree to: a. Abide by the Office of Administrative Law (OAL) rules and all applicable New Jersey court rules, including all disciplinary rules; b. Consent to the appointment of the Clerk of the Supreme Court as agent upon whom service of process may be made for all actions against me or my firm that may arise out of my participation in this matter; c. Notify the OAL immediately of any matter affecting my standing at the bar of any court; and d. Have all pleadings, briefs and other papers filed with the OAL signed by the attorney of record. Sworn to and subscribed before me this _______ day of _________________, 20____. ______________________________ , Esq. American LegalNet, Inc. www.FormsWorkFlow.com