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`United States District Court
`Western District of Washington
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`ÝÇÉÛÛ ÙÎÑËÐ ÔÌÜòô
`
`V.
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`ØÌÝ ÝÑÎÐÑÎßÌ×ÑÒå ßÒÜ ØÌÝ ßÓÛÎ×Ýßô
`×ÒÝò
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`Case Number:
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`îæïéóÝÊóððçíîóÖÔÎ
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`APPLICATION FOR LEAVE TO APPEAR
`PRO HAC VICE
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`̧ Éò Ý¿´´¿¸¿²
`
`ØÌÝ Ý±®°±®¿¬·±² ¿²¼ ØÌÝ ß³»®·½¿ô ײ½ò
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`× °®»»²¬´§ ®»°®»»²¬ Ü»º»²¼¿²¬ ØÌÝ Ý±®°±®¿¬·±² ¿²¼ ØÌÝ ß³»®·½¿ô ײ½ò
`
`̧ Éò Ý¿´´¿¸¿²
`all applicable local rules;
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`not disciplinary proceedings against me.
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`I declare under penalty of perjury that the foregoing is true and correct.
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`ðïñïçñîðïè
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`Date:
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`Signature of Applicant: s/
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`̧ Éò Ý¿´´¿¸¿²
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`Page - 1 of 3
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`Case 2:17-cv-00932-JLR Document 48 Filed 01/19/18 Page 2 of 3
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`Applicant's Name:
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`̧ Éò Ý¿´´¿¸¿²
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`É·´±² ͱ²·²· Ù±±¼®·½¸ ú ਪ· ÐÝ
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`Street Address 1:
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`Address Line 2:
`Ô± ß²¹»´»
`City:
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`êíí É ë¬¸ ͬ®»»¬
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`Í«·¬» ïëëð
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`Ýß
` State:
`øíîí÷ îïðóîçíì
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`çððéï
` Zip:
`íïîëìè
` Bar #
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` State
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`Ýß
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`¬½¿´´¿¸¿²à©¹®ò½±³
`Primary E-mail Address:
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`Secondary E-mail Address:
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` ¹°±²½»à©¹®ò½±³
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`STATEMENT OF LOCAL COUNSEL
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`applicant
`̧ Éò Ý¿´´¿¸¿²
`assigned by the court.
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` is unable to be present upon any date
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`ðïñïçñîðïè
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`Date:
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` Signature of Local Counsel: s/
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`Ù®»¹±®§ Ôò É¿¬¬
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`Local Counsel's Name:
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`Ù®»¹±®§ Ôò É¿¬¬
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`É·´±² ͱ²·²· Ù±±¼®·½¸ ú ਪ· ÐÝ
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`Street Address 1:
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`Address Line 2:
`Í»¿¬¬´»
`City:
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`éðï Ú·º¬¸ ߪ»²«»
`
`Í«·¬» ëïðð
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` State:
`øîðê÷ èèíóîëðð
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`Éß
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`çèïðì
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` Zip:
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` Bar #
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`Page - 2 of 3
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`Case 2:17-cv-00932-JLR Document 48 Filed 01/19/18 Page 3 of 3
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`1.
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`2.
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`3.
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`4.
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`6.
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`against unauthorized use.
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`and advise you accordingly.
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`the entry of an order or judgment.
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`psc.uscourts.gov.
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`ðïñïçñîðïè
`Date Signed
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` Signature s/
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`̧ Éò Ý¿´´¿¸¿²
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`Page - 3 of 3
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