Affidavit Form Of Movant/affidavit Of Proposed Admittee
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1IN THE UNITED STATES DISTRICT COURT FOR
THE WESTERN DISTRICT OF MISSOURI
PETITION FOR ADMISSION PRO HAC VICE
Affidavit of Movant
I,________________________________, an active member in good standing of the Bar of the United States
District Court for the Western District of Missouri, request that this court admit pro hac vice,
__________________________, an attorney admitted to practice in the United States District Court in the district of
his/her residence and the State of ___________________, but not admitted to the Bar of this court, who will be counsel
for the
, in the case(s) listed below. I am aware that the local rules of this court require that I
participate in the preparation and presentation of said case(s), and that I accept service of all papers served. I also
understand and agree that if the admittee does not sign up to receive CM/ECF filings, I will be responsible for notifying
the admittee of all papers served by CM/ECF.
______________________________________
Signature of Movant/Attorney
MO Bar Number
____________________________________
______________________________________
Date
Address
____________________________________
______________________________________
Phone
______________________________________
Affidavit of Proposed Admittee
I,
, certify that I reside outside the
boundaries of the Western District of Missouri and am not admitted to the Bar of this court. I am a member in good
standing of the State of ___________________________ and the United States District Court of
___________________________________________________________. I understand that Local Rule 83.5(l) requires
that I be a member in good standing in the U.S. District Court for the district where I reside. I reside in
____________________________ (city/state). I understand that if this court grants me admission pro hac vice, the
movant bringing this motion must participate in the preparation and presentation of the matters listed below and must
accept service of all papers served. I am aware that I can register to receive CM/ECF filings. I understand and agree that
should I choose not to register for CM/ECF, I will arrange with movant to keep me advised of papers served and filed in
this case.
Case Number(s):
Case Title(s)
_____________________________
____________________________________________________
_____________________________
____________________________________________________
_____________________________
____________________________________________________
Date: _______________________
Signature: __________________________________________
State Bar Number: ________________________
Address: __________________________________
District Court Bar Number:__________________
__________________________________
Phone: ___________________________________
Email: ____________________________________
Pursuant to WDMO Local Rule 83.5(l) a fee of $50 is required for each case in which the attorney is seeking
admittance.
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