UNITED STATES BANKRUTPCY COURT EASTERN DISTRICT OF NEW YORK -------------------------------------------------------------------x In re: AFFIRMATION IN SUPPORT OF MOTION TO ADMIT COUNSEL PRO HAC VICE Bankruptcy No. -------------------------------------------------------------------x ___________________________________, an attorney duly admitted to practice law in the (Movant) State of ______________________, hereby affirms as follows under penalty of perjury: associated with the law 1. I am ______________________ firm of: th Name: ____________________________________________________________________ Address:___________________________________________________________________ ___________________________________________________________________ Telephone No.____________________________ 2. I submit this affirmation in support of my motion for admission to practice pro hac vice in the abovecaptioned matter. 3. As shown in the Certificate(s) of Good Standing annexed hereto, I am a member in good standing in the Bar of the State(s) of ________________________________________ and/or the U.S. District Court for the __________________________ District of _______________________. (If no such certificates are annexed hereto, your affirmant will file the same with the Clerk of the Bankruptcy Court within 10 business days from the date hereof.) 4. There are no pending disciplinary proceedings against me in any State or Federal court. (If there are any, describe the pending disciplinary proceedings.) 5. Wherefore, your affirmant respectfully requests that he/she be permitted to appear as counsel and advocate pro hac vice in this one case. Dated: _______________________________ _______________________________ (Print or Type Name) Signature of Movant affirmbk:prohac.aff.74c Rev. 12/09 American LegalNet, Inc. www.FormsWorkFlow.com