Registration Statement For Pro Hac Vice Attorneys
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2Please note that ONLY THIS FORM, FILLED OUT ON THE WEBSITE, WILL BE ACCEPTED. Handwritten, annotated, copied, scanned or modified forms will be returned.
BOARD OF BAR OVERSEERS
REGISTRATION STATEMENT FOR PRO HAC VICE ATTORNEYS
Attorney name (first MI last, suffix):
Email address:
Complete Business/Mailing Address:
Board of Bar Overseers
Administrative Use Only
Date Received:________________
Amount Paid:________________
Date confirmation mailed:_____________
Business phone:
Court in which pro hac vice admission is sought:
Contact number for court:
Party to be represented:
Docket number of case (if available):
Jurisdictions to which you have been admitted:
(Use second page for additional jurisdictions.)
Type
Jurisdiction
License number
I certify that (check one): (
) the party I am representing in the case for which I am seeking pro hac vice admission is an indigent client, and I
understand that no pro hac vice fee is due, or ( ) I have included the required pro hac vice fee.
Further, I certify, under the pains and penalties of perjury, that I am admitted to practice and in good standing in every jurisdiction where I am
admitted, and I acknowledge that I am subject to discipline by the Massachusetts Supreme Judicial Court and the Board of Bar Overseers. I
understand I am limited in my legal practice in Massachusetts to the case identified above.
I certify the information I have supplied the Board of Bar Overseers is true and complete.
Signature (
)
Date:
Please sign inside box above.
Sign, print and mail original form to: Board of Bar Overseers, 99 High Street, 2nd Floor, Boston, MA 02110-2320
PHC-125
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