1 UNITED STATE BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON 2 3 In re: No: 4 APPLICATION FOR LEAVE TO APPEAR PRO HAC VICE 5 Debtor 6 7 8 9 Pursuant to Local General Rule 2(d) of the United States District Court for the Western District of hereby applies for permission to participate Washington, as counsel in the above-entitled bankruptcy action on behalf of the following party or parties: 10 11 . The particular need for my appearance and participation is: 12 13 14 15 16 17 18 19 20 . I, with all applicable rules, including, but not limited to, General Rule 2 of the United States District Court for the Western District of Washington which requires that I associate with local counsel who shall sign all pleadings prior to filing, and the Local Bankruptcy Rules of the Western District of Washington (“LBR”), including LBR 5005-1 which governs electronic filing. I have not been disbarred or formally censured by a court of record or by a state bar association. There are no pending disciplinary proceedings against me. I am in good standing with the bar of the State of 21 22 23 24 , understand that I am charged with knowing and complying . With this application I will tender the pro hac vice fee of $150.00 to the Bankruptcy Clerk’s office via electronic payment. I declare under penalty of perjury that the foregoing is true and correct. 25 26 27 28 DATED: . Signature of Applicant Attorney Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 1 APPLICATION FOR LEAVE TO APPEAR PRO HAC VICE - page 2 2 3 4 Applicant's Name: Bar # _______________ State: _______________________ 5 Applicant's Law Firm: 6 Applicant's Address: 7 8 Telephone No: 9 10 11 12 STATEMENT OF LOCAL COUNSEL I am authorized and will be prepared to handle this matter, including trial, in the event the applicant, 13 , is unable to be present upon any date assigned by the court. If this 14 application is filed electronically, I understand that the provisions of LBR 5005-1(d)(3) apply and that I am 15 required to retain documentation evidencing the signature of the applicant. 16 DATED: . 17 18 Signature of Local Counsel 19 20 Local Counsel Name & WSBA Bar ID Number: 21 Local Counsel Law Firm: 22 Local Counsel Address: 23 24 Telephone No: 25 26 APPLICATION FOR LEAVE TO APPEAR PRO HAC VICE (rev. 06.14.2011) 27 28 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON 6 7 8 In re 9 No. 10 11 ORDER ON PRO HAC VICE APPLICATION Debtor. 12 13 This matter came before the Court on the Application for Leave to Appear Pro Hac Vice 14 , (the “Application”) submitted by , 15 [applicant’s name] seeking permission to appear and participate as counsel for 16 ,[party or parties represented] in the above-captioned matter. The 17 Court having reviewed the Application, it is hereby 18 ORDERED that the Application is GRANTED. 19 20 / / / END OF ORDER / / / 21 22 23 24 25 26 ORDER American LegalNet, Inc. www.FormsWorkFlow.com