STATE OF RHODE ISLAND , SC v. _______________ COURT : : : : : C.A. No. ATTORNEY CERTIFICATION FOR PRO HAC VICE ADMISSION 1. I certify that I am a member in good standing of the bar of the State(s) of _____________________________, without any restriction on my eligibility to practice, and that I understand my obligation to notify this Court immediately of any change respecting my status in this respect. 2. Within the preceding sixty (60) months, I was or am currently admitted pro hac vice, or have applied to be admitted pro hac vice, in the following cases or proceedings in this State: ________________________________________________________________________ 3. I have read, acknowledge, and agree to observe and to be bound by the local rules and orders of this Court, including the Rules of Professional Conduct of the Rhode Island Supreme Court, as the standard of conduct for all attorneys appearing before it. 4. I acknowledge that if specially admitted to appear in the above-entitled matter that I will be subject to the disciplinary procedures of the Rhode Island Supreme Court. I hereby authorize the disciplinary authorities of the bar of the State(s) of __________________________ to release any information concerning my practice in said State(s) pursuant to the request of the Disciplinary Counsel of the Rhode Island Supreme Court. 5. For purposes of this case I have associated with local associate counsel identified below, and have read, acknowledge, and will observe the requirements of this Court respecting the participation of local associate counsel, recognizing that failure to do so may result in my being disqualified, either upon the Court’s motion or motion of other parties in the case. American LegalNet, Inc. www.FormsWorkflow.com ____________________________________ Signature ____________________________________ Name ____________________________________ Firm Name ____________________________________ Business Address CERTIFICATION OF LOCAL ASSOCIATE COUNSEL I certify that I have read and join in the foregoing Certification, and acknowledge and agree to observe the requirements of this Court as related to the participation and responsibilities of local associate counsel. ______________________________ Signature ____________________________________ Local Associate Counsel RI Bar ID # ____________________________________ Firm Name ____________________________________ Business Address American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com