IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA Plaintiff(s), v. (CIVIL)(CRIMINAL) NO: Defendant(s). APPLICATION FOR ADMISSION PRO HAC VICE I verify that I have fully complied with Local Rule of General Practice and Procedure 83.02 as it relates to admission to practice pro hac vice. Applicant’s Name Representing (Party Name) Name of Applicant’s Firm Applicant’s Office Address Applicant’s Office Telephone Number Applicant’s Office Fax Number ___________________________________ Applicant’s Email Address Bar number where admitted, with name, address, and telephone of State Bars where admitted: Bar # and State: List all matters before West Virginia tribunals or judicial bodies in which the applicant is or has been involved in the preceding twenty-four (24) months: PROVIDE ATTACHMENT WITH ADDITIONAL INFORMATION IF NECESSARY American LegalNet, Inc. www.FormsWorkFlow.com All matters before West Virginia tribunals or judicial bodies in which member of applicant’s firm, any partnership or corporation is or has been involved in the preceding twenty-four (24) months: PROVIDE ATTACHMENT WITH ADDITIONAL INFORMATION IF NECESSARY I understand that admission to practice pro hac vice will result in my registration in the Case Management/Electronic Case Filing system. By this registration, I agree to abide by the requirements set forth in the Federal Rules,Federal Statutes and the Local Rules, Adm inistrative Orders, procedures and policies of the United States District Court for the Northern District of West Virginia. (See https://racerweb.wvnd.uscourt.gov for further information). I understand that attorneys admitted pro hac vice will have privileges to view official docket sheets and documents associated with cases and query case reports for cases on the CM/ECF system using the Court-assigned read only login and password, and that I m submit all filings electronically ust through local counsel. Registration constitutes my consent to service by electronic means pursuant to the Federal Rules. I certify that I have: 1) Submitted with this application therequisite fee of Two-Hundred Dollars ($200.00) payable to the Clerk of the Court of the United States District Court for the Northern District of West Virginia, and 2) Paid to the West Virginia State Bar the West Virginia State Bar pro hac vice fee pursuant to Rule 8.0 of the Rules of Admission for the West Virginia State Bar. I certify that the foregoing application is true and correct. I hereby represent that I am a member in good standing with the bar of every jurisdiction in which I am admitted and my privileges to practice law and my membership in any bar association have never been amended, modified, suspended, revoked or otherwise limited inany way in any court, district, state, commonwealth or other jurisdiction. I also certifythat I have never been convicted of a felony. I agree to complywith all laws, rules, and regulations of the United States Courts where applicable. If unable to make the above representation, please attach an explanation. Name of Responsible Local Attorney Office Local Attorney Telephone Number ___________________________________ Responsible Attorney’s Email Address Signature of Applicant Name of Responsible Attorney’s Firm Responsible Attorney’s Office Address Pursuant to Local Rule of General Practice and Proc edure 83.02, I have read the foregoing application and, by my endorsement hereon, agree to be a responsible local attorney the above-styled in matter. I certify that I am an active member in good standing of the West Virginia Bar and that I maintain an actual office in West Virginia from which I practice law on a daily basis. I hereby verify that the attorney moving for pro hac vice admission is a member of the bar or bars listed on page 1 of this application. Signature of Responsible Local Attorney American LegalNet, Inc. www.FormsWorkFlow.com IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA Plaintiff(s), v. (CIVIL)(CRIMINAL) NO: Defendant(s). ORDER Upon consideration of the foregoing Application for Adm ission Pro Hac Vice of _________________________________________, it is ORDERED that the Application f or Admission Pro Hac Vice be, and the same is hereby, APPROVED and that the applicant m ay appear pro hac vice in this matter on behalf of the represented party. ENTER: United States District Judge American LegalNet, Inc. www.FormsWorkFlow.com