IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA In Re: Debtor Movant v. Respondent (if applicable) : : : : : : : : Bankruptcy No. Chapter Related to Document No. Hearing Date and Time: MOTION FOR PRO HAC VICE ADMISSION 1. This motion for admission pro hac vice is being filed on behalf of: (Applicant's name, firm name, address, phone number, email address, Bar I.D. Number and State of Admission) by (Movant's name as identified in Paragraph 4 below). Applicant represents (Name and address of client) . Accompanying this Motion is the required $70 filing fee paid using the Movant's CM/ECF account at the time of filing. Applicant is a member in good standing of the Bar of_______________________, is not the subject of any pending disciplinary matters, is personally familiar with the Local Bankruptcy Rules of the United States Bankruptcy Court for the Western District of Pennsylvania and shall abide by those Local Bankruptcy Rules. Applicant will be associated with the following attorney acting in this matter as local counsel, who is a member of the Bar of the Bankruptcy Court for the Western District of Pennsylvania: (Movant's name, firm name, address, phone number, email address, Bar I.D. Number and State of Admission). Applicant and Movant have read and shall comply with Local Bankruptcy Rules 9010-1(b), 9010-1(c) and 9010-1(d). Applicant has previously received Pro Hac Vice admission to this Court by Orders dated _____________ in the following matters: (Applicant must identify each prior admission). 2. 3. 4. 5. 6. _____________ Date By:______________________________________________ Signature of Movant ______________________________________________ Typed Name ______________________________________________ Address ______________________________________________ Phone No. ______________________________________________ List Bar I.D. and State of Admission PAWB Local Form 18 (03/17) American LegalNet, Inc. www.FormsWorkFlow.com