United States Court of Appeals for the Sixth Circuit APPLICATION FOR ADMISSION TO THE BAR APPLICATION: I, , do hereby make application for admission to the bar of the United States Court of Appeals for the Sixth Circuit. My Personal statement showing my eligibility for membership is as follows: I am admitted to practice in the following court(s) OATH: I, , do solemnly swear (or affirm) that I will demean myself as an attorney and counselor of this Court, uprightly and according to law; and that I will support the Constitution of the United States of America. Subscribed and sworn to before me this day of , 20 Signature of Applicant Signature of Notary (or Court of Appeals Deputy Clerk) FOR NOTARY: My commission expires on MOTION: I, member of the bar of this court, do hereby move the admission of the above attorney. Signature of Movant , 20 ,a APPLICATION INFORMATION: (Please print) Mr. Ms. Name: (Last) E-mail Address: Firm: Address: City: Last 4 digits of SSN: Phone: State: Zip: Fax: (First) (Middle) ADMISSION FEE: Fee for admission to the bar of this court is $231.00 (this includes a local fee of $50.00). Payment may be made by cash, check, money order, credit or debit card. Check and money order should be made payable to "Clerk, U.S. Court of Appeals, Sixth Circuit". Go to http://www.ca6.uscourts.gov/fees to pay with a credit or debit card. FOR CLERK'S OFFICE USE: Fee Paid: Comments: Admitted this day of , 20 Deborah Hunt, Clerk United States Court of Appeals for the Sixth Circuit By: 6CA-14 11/16 American LegalNet, Inc. www.FormsWorkFlow.com Yes No Date Paid: