` Revised: 9/3/2015
`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF TEXAS
`__________DIVISION
`APPLICATION TO APPEAR PRO HAC VICE
`
`1.This application is being made for the following: Case #__________________________________
`Style/Parties:________________________________________________________________________
`2. Applicant is representing the following party/ies: __________________________________________
`3.Applicant was admitted to practice in __________ (state) on _____________________ (date).
`4. Applicant is in good standing and is otherwise eligible to practice law before this court.
`5. Applicant is not currently suspended or disbarred in any other court.
`6. Applicant had an application for admission to practice before another court denied (please
`circle appropriate language). If so, give complete information on a separate page.
`7. Applicant
`
` ever had the privilege to practice before another court suspended (please circle).
`If so, give complete information on a separate page.
`8. Applicant
` been disciplined by a court or Bar Association or committee thereof that would
`reflect unfavorably upon applicant’s conduct, competency or fitness as a member of the Bar (please
`circle). If so, give complete information on a separate page.
`9. Describe in detail on a separate page any charges, arrests or convictions for criminal offense(s) filed
`against you. Omit minor traffic offenses and misdemeanor offenses committed prior to age 18.
`10. There are no pending grievances or criminal matters pending against the applicant.
`11. Applicant has been admitted to practice in the following courts:
`______________________________________________________________________________
`12. Applicant has read and will comply with the Local Rules of the Eastern District of Texas, including
`Rule AT-3, the “Standards of Practice to be Observed by Attorneys.”
`13. Applicant understands that he/she is being admitted for the limited purpose of appearing in the case
`specified above only.
`Application Oath:
`I, __________________________________________do solemnly swear (or affirm) that the
`above information is true; that I will discharge the duties of attorney and counselor of this court faithfully;
`that I will demean myself uprightly under the law and the highest ethics of our profession; and that I will
`support and defend the Constitution of the United States.
`
`Date _______________
`
`Signature __________________________________ (/s/Signature)
`
`
`
`Case 5:19-cv-00036-RWS Document 16 Filed 03/18/19 Page 2 of 3 PageID #: 302
`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF TEXAS
`APPLICATION TO APPEAR PRO HAC VICE (Continued)
`
`Name (please print) _____________________________________
`Bar Number /State______________________________________
`Firm Name:
`________________________________________
`Address/P.O. Box: ____________________________________
`City/State/Zip: _________________________________________
`Telephone #: _________________________________________
`Fax #: ______________________________________________
`E-mail Address: ________________________________________
`Secondary E-Mail Address: _______________________________
`
`This application has been approved for the court on: _______________________________________
`
`David A. O'Toole, Clerk
`U.S. District Court, Eastern District of Texas
`
`By _______________________________________
`Deputy Clerk
`
`
`
`Case 5:19-cv-00036-RWS Document 16 Filed 03/18/19 Page 3 of 3 PageID #: 303
`Case 5:19-cv-00036—RWS Document 16 Filed 03/18/19 Page 3 of 3 PageID #: 303
`
`This may be used to answer question 9.
`
`9. Describe in detail on a separate page any charges, arrests or convictions
`
`for criminal offense(s) filedagainst you. Omit minor traffic offenses and
`
`misdemeanor offenses committed prior to age 18.
`
`
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