United States District Court

Southern District of Mississippi

Plaintiff

v.	Civil Action

No.

Defendant

APPLICATION FOR ADMISSION PRO HAC VICE

(A)	Name:

Firm Name:

Office Address:

City:	State	Zip

Telephone:	Fax:

E-Mail:

(B)	Client(s):

Address:

City:	State	Zip

Telephone:	Fax:

The following information is optional:

Has Applicant had a prior or continuing representation in other matters of one or more of the clients Applicant proposes to represent and is there a relationship between those other matter(s) and the proceeding for which Applicant seeks admission?

Does Applicant have any special experience, expertise, or other factor that Applicant believes makes it particularly desirable that Applicant be permitted to represent the client(s) Applicant proposes to represent in this case?

(C)	Applicant is admitted to practice in the:

______	State of ____________________

District of Columbia

and is currently in good standing with that Court. A certificate to that effect, issued within ninety days of the date of this Application, is enclosed; the physical address, telephone number and website/email address for that admitting Court are:

All other courts before which Applicant has been admitted to practice:

Jurisdiction	Period of Admission

Yes	No

(D)	Has Applicant been denied admission pro hac vice in this state?

Has Applicant had admission pro hac vice revoked in this state?

Has Applicant been formally disciplined or sanctioned by any court

in this state in the last five years?

If the answer was "yes," describe, as to each such proceeding, the nature of the allegations, the name of the person or authority bringing such proceedings; the dates the proceedings were initiated and finally concluded; the style of the proceedings; and the findings made and actions taken in connection with those proceedings:

Yes	No

(E)	Has any formal, written disciplinary proceeding ever been

brought against Applicant by a disciplinary authority in any

other jurisdiction within the last five years?

If the answer was "yes," describe, as to each such proceeding, the nature of the allegations; the name of the person or authority bringing such proceedings; the date the proceedings were initiated and finally concluded; the style of the proceedings; and the findings made and actions taken in connection with those proceedings.

Yes	No

(F)	Has Applicant been formally held in contempt or otherwise

sanctioned by any court in a written order in the last five years

for disobeying its rules or orders?

If the answer was "yes," describe, as to each such order, the nature of the allegations, the name of the court before which such proceedings were conducted; the date of the contempt order or sanction, the caption of the proceedings, and the substances of the court's rulings	(a copy of the written order or transcript of the oral rulings must be attached to the
application).

(G)	Please identify each proceeding in which Applicant has filed an application to proceed pro hac vice in this state within the preceding two years, as follows:

Name and	Date of	Outcome of

Address of Court	Application	Application

(H)	Please identify each case in which Applicant has appeared as counsel pro hac vice in this state within the immediately preceding twelve months, is presently appearing as counsel pro hac vice, or has pending applications for admission to appear pro hac vice, as follows:

Name and

Address of Court	Style of Case

Yes	No

(I)	Has Applicant read and become familiar with all the Local

Uniform Civil Rules of the United States District Courts

for the Northern and Southern Districts of Mississippi?

Has Applicant read and become familiar with the

Mississippi Rules of Professional Conduct?

(J)	Please provide the following information about the resident attorney who has been associated for this case:

Name and Bar No:

Firm Name:

Office Address:

City:	State Zip

Telephone:	Fax:

E-Mail:

(K)	The undersigned resident attorney certifies that he/she agrees to the association with Applicant in this matter and to the appearance as attorney of record with Applicant.

Resident Attorney

I certify that the information provided in this Application is true and correct.

Date	Applicant's Signature

Unless exempted by Local Rule 83.1(d)(5), the application fee established by this Court must be enclosed with this Application.

CERTIFICATE OF SERVICE

The undersigned Applicant certifies that a copy of this Application for Admission Pro Hac Vice has been mailed or otherwise served on this date on all parties who have appeared in this case.

This the _______ day of ______________, 20__.

Applicant