UNITED STATES COURT OF APPEALS FOR THE TENTH CIRCUIT Entry of Appearance - Pro Se v. Case No. INSTRUCTIONS: A PARTY DESIRING TO APPEAR WITHOUT COUNSEL SHALL NOTIFY THE CLERK BY COMPLETING AND SIGNING THIS FORM. THE FEDERAL RULES OF APPELLATE PROCEDURE AND TENTH CIRCUIT RULES REQUIRE THAT ALL PAPERS SUBMITTED TO THE COURT FOR FILING BE SIGNED BY THE FILING PARTY AND THAT COPIES BE SERVED ON OPPOSING PARTIES OR THEIR COUNSEL, IF REPRESENTED BY COUNSEL. THE ORIGINAL OF EVERY PAPER SUBMITTED FOR FILING MUST CONTAIN PROOF OF SERVICE IN A FORM SIMILAR TO THAT ON THE REVERSE OF THIS FORM. ANY PAPER THAT DOES NOT CONTAIN THE REQUIRED PROOF OF SERVICE MAY BE DISREGARDED BY THE COURT OR RETURNED. I hereby notify the clerk that I am appearing pro se as the _____________________________________________________________________in (Appellant, Petitioner, Appellee or Respondent) this case. All notices regarding the case should be sent to me at the address below. If my mailing address changes, I will promptly notify the clerk in writing of my new address. Further, in accordance with 10th Cir. R. 46.1, I certify: (Check one.) 9 9 All parties to this litigation, including parties who are now or have been interested in this litigation, are revealed by the caption for this appeal, or There are parties interested in this litigation that do not appear in the caption for this appeal, and they are listed on the back of this form. _________________________________ Signature ________________________________ Name ________________________________ Mailing Address ________________________________ City State Zip Code A-5a Pro Se Entry of Appearance Form 10/09 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that on ____________________________ I sent a copy of [date] the Pro Se Entry of Appearance Form to: _________________________________ at_________________________________________________________________ ______________________________________________, the last known address/email address, by ____________________________. [state method of service] _________________________ Date _____________________________ Signature CERTIFICATE OF INTERESTED PARTIES (attached additional pages if necessary) A-5a Pro Se Entry of Appearance Form 10/09 American LegalNet, Inc. www.FormsWorkFlow.com