IN THE CHANCERY COURT OF SHELBY COUNTY TENNESSEE _________________________________ Plaintiff vs. Docket No._______________________ _________________________________ Defendant _________________________________________________________________________________ AFFIDAVIT IN SUPPORT OF COMPLIANCE WITH TENNESSEE SUPREME COURT RULE 19 GOVERNING APPEARANCE OF OUT-OF-STATE COUNSEL PRO HAC VICE Name: ___________________________________________________________________________ Office Address and Telephone Number: ________________________________________________ Residence Address and Telephone Number: ________________________________________________ The undersigned, after having been duly sworn, states: I am an attorney currently licensed, in good standing and admitted to practice before the court of last resort in the state of ________________________, where I reside. No disciplinary action or investigation of my conduct is pending. I have associated __________________________________________________________, at ________________________________________________________________________________, telephone number _________________ who is licensed, in good standing, resides and maintains a law office in Tennessee. I agree to subject myself to the jurisdiction of the courts of Tennessee in any manner arising out of my conduct in these proceedings and I agree to be bound by the Code of Professional Responsibility applicable to Tennessee lawyers and the interpretation of this Code by Tennessee Courts. _____________________________________________________ BPR# _____________________ Sworn to and subscribed before me this _________ day of _____________________, Kenny W. Armstrong, Clerk & Master by ______________________________________ D.C.&M. /Notary My Commission Expires: ____________________ Form A0-05/04 American LegalNet, Inc. www.USCourtForms.com