UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH PRO HAC VICE ADMISSION APPLICATION INSTRUCTIONS Admission Fee: $15.00 payable by check or money order to Clerk, U.S. District Court. The fee will cover membership for the duration of the case or twelve (12) months, whichever is longer. Pro hac vice applicants who paid the fee within the past 12 months and who are requesting admission to practice in a case other than that originally specified when the fee was paid should check the blank below and indicate the date of their most recent pro hac vice admission to this Court. Applicants are required to complete and submit this form for each case in which they participate as pro hac vice counsel. ______ Applicant was previously admitted pro hac vice to this Court in case # _______________; month and year of most recent pro hac vice admission and payment of fee was _______________, ______. Application: Please type or print legibly and complete all blanks. Designated Local Counsel: Must be an active member in good standing of the Utah State Bar and the Bar of this Court. Mandatory Requirements: 1. Provide and attach a separate list by number and title of all cases filed in this Court in which applicant has appeared as counsel in the past five years. 2. Type local counsel’s name below the signature line and enter the bar number in the space provided. 3. If more than one attorney from the same firm is seeking pro hac vice admission in this case, please indicate which attorney will serve as lead counsel for purposes of receiving official court notices and other case-related documents. American LegalNet, Inc. www.FormsWorkflow.com Attorney Name Firm Name Firm Address Phone Number Fax Number E-Mail Address UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH _____________________________________________________________________________ In re: Case No. Debtor(s). Chapter _____________________________________________________________________________ MOTION AND CONSENT OF DESIGNATED ASSOCIATE LOCAL COUNSEL I, ___________________________________, hereby move the pro hac vice admission of applicant to practice in this Court. I hereby agree to serve as designated local counsel for the subject case; to readily communicate with opposing counsel and the Court regarding the conduct of this case; and to accept papers when served and recognize my responsibility and full authority to act for and on behalf of the client in all case-related proceedings, including hearings, pretrial conferences, and trials, should applicant fail to respond to any Court order. Dated: _______________________________________________ (Signature of Local Counsel) (Utah Bar Number) APPLICATION FOR ADMISSION PRO HAC VICE Applicant, ___________________________________, hereby requests permission to appear pro hac vice in the subject case. Applicant states under penalty of perjury that he/she is a member in good standing of the bar of the highest court of a state or the District of Columbia; is (i) ___ a non-resident of the state of Utah or, (ii) ___ a new resident who has applied for admission to the Utah State Bar and will take the bar examination at the next scheduled date; and, under DUCivR83-1.1(d) and Bankr. D. Ut. LBR 2090-1, has associated local counsel in American LegalNet, Inc. www.FormsWorkflow.com this case. Applicant’s address, office telephone, fax number, e-mail address and the courts to which admitted, and the respective dates of admission are provided as required. Applicant designates _________________________________ as associate local counsel. Check if applicant is lead counsel: ______ Dated: __________________________________________ (Signature of Applicant) American LegalNet, Inc. www.FormsWorkflow.com Name of Applicant: ________________________________________________ Business Address: _________________________________________________ _________________________________________________ _________________________________________________ Main Office Telephone Number: (_____)______________ Fax Number: (_____)__________________ E-mail Address: ___________________________ BAR ADMISSION HISTORY COURTS TO WHICH ADMITTED LOCATION DATE OF ADMISSION ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (If additional space is needed, attach separate sheet.) PRIOR PRO HAC VICE ADMISSIONS IN THIS DISTRICT CASE TITLE CASE NUMBER DATE OF ADMISSION ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (If additional space is needed, attach separate sheet.) American LegalNet, Inc. www.FormsWorkflow.com Attorney Name Firm Name Firm Address Phone Number Fax Number E-Mail Address UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH ______________________________________________________________________________ In re: Case No. Debtor(s). Chapter ______________________________________________________________________________ ORDER OF ADMISSION It appearing to the Court that Applicant, _________________, meets the pro hac vice admission requirements of DUCivR 83-1.1(d) and Bankr. D. Ut. LBR 2090-1, the Motion for Applicant’s Admission Pro Hac Vice in the United States Bankruptcy Court, District of Utah in the subject case is GRANTED. The Applicant’s contact information is as follows: Business Address: _________________________________________________ _________________________________________________ _________________________________________________ Main Office Telephone Number: (_____)______________ Fax Number: (_____)__________________ E-mail Address: ___________________________ ------------------------------------------------END OF DOCUMENT--------------------------------------- American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com