UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF TENNESSEE Plaintiff, v. Case No. Defendant. MOTION FOR ADMISSION PRO HAC VICE The undersigned counsel for [name of party] hereby moves for admission to appear pro hac vice in this action. I hereby certify that I am a member in good standing of the [provide the United States District Court or United States appellate court of which movant is a member]. Attached is a Certificate of Good Standing from that court. I also declare under penalty of perjury that I am not, nor have I ever been, the subject of disciplinary or criminal proceedings, except as disclosed herein. [Describe all pending or previous disciplinary proceedings and outcome of each. Attached additional sheets as necessary.] /s/ Signature Name and State Bar Number [include state where admitted]: Business Address: Local Address [if different than business address]: Phone: Email: CERTIFICATE OF SERVICE [Include certificate of service in compliance with Local Rule 5.01] **FEE: $100.00 [Fee may be paid through the credit card module in ECF or payment may be forwarded to the Clerk within 21 days of the motion. If forwarded to the Clerk, payment should be in the form of a check, cashier222s check or money order payable to the Clerk, U.S. District Court, 801 Broadway, Room 800, Nashville, TN 37203.) American LegalNet, Inc. www.FormsWorkFlow.com