For office use only Clerk of the Wyoming Supreme CourtSupreme Court Building2301 Capitol AvenueCheyenne, WY 82001(307)777-7316 Petition and Application for Admission INSTRUCTIONS TO THE APPLICANT: Before you begin, please read the Rules and Procedures Governing Admission to the Practice of Law, Filing Instructions and Frequently Asked Questions. If your application Full Name Please list any other names you have used or by which you are known. Contact Information Street Address Mailing Address City State Zip Phone Numbers Home Cell E-mail Address Date of Birth (MM/DD/YYYY) Gender M F NCBE Number (8 digits)N Revised //1 to the Wyoming State Bar by Motion Have you previously applied for admission to the Wyoming State Bar? If so, please providethemonth and year of the most recent application:Multistate Professional Responsibility Examination (MPRE):Date of MPRE:List any other jurisdictions in which you are seeking admission: (MM/DD/YYYY) American LegalNet, Inc. www.FormsWorkFlow.com 4.List all jurisdictions you are now or have ever been admitted to practice law: from the highest court in all jurisdictions in which you are admitted).5.Has your membership status in all jurisdictions to which you have been admitted beencontinuous and in good standing? Yes No (P6.Is there any incident or fact in your background not otherwise referenced on this application oradmission to the Wyoming State Bar or which you feel requires additional explanation? Yes (P No STATE OF ) )ss.COUNTY OF )I, , being sworn on oath depose and say that I have read the Rules and Procedures Govern-ing Admission to the Practice of Law and the foregoing application and that the information contained herein is true and cor-rect. I understand that this application is a continuing application which must accurately relate the facts on the date that I am for admission to the Wyoming State Bar. Signature of Applicant Signed and sworn to before me this day of 20 . Notary Public American LegalNet, Inc. www.FormsWorkFlow.com