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United States District Court Northern District of IllinoisMOTION FOR LEAVE TO APPEAR PRO HAC VICE Case Title:Plantiff(s)VS.Defendant(s)Case Number:Judge:I,hereby apply to the Courtunder Local Rule 83.14 for permission to appear and participate in the above-entitled action on behalf ofby whom I have been retained.I am a member in good standing and eligible to practice before the following courts:Title of Court DateAdmitted I have currently, or within the year preceding the date of this application, made pro hac vice applications to thisCourt in the following actions:Case NumberCase TitleDate of Application(Granted or Denied)**If denied, please explain:(Attach additional form ifnecessary)Pursuant to Local Rule 83.15(a), applicants who do not have an office within the Northern District of Illinois must designate, at thetime of filing their initial notice or pleading, a member of the bar of this Court having an office within this District upon who service ofpapers may be made.Has the applicant designated local counsel?YesNoIf you have not designated local counsel, Local Rule 83.15(b) provides that the designation must be made within thirty (30) days. American LegalNet, Inc. www.FormsWorkFlow.com Has the applicant ever been:censured, suspended, disbarred, or otherwise disciplined by any court?YesNoor is the applicant currently the subject of an investigation of theapplicant222s professional conduct?YesNotransferred to inactive status, voluntarily withdrawn, or resigned from thebar of any court?YesNodenied admission to the bar of any court?YesNoheld in contempt of court?YesNoNOTE: If the answer to any of the above questions is yes, please attach a brief description of the incident(s) and the applicant222s currentstatus before any court, or any agency thereof, where disciplinary sanctions were imposed, or where an investigation or investigationsof the applicant222s conduct may have been instituted.I have read the Rules of Professional Conduct for the Northern District of Illinois and the Standards for Professional Conduct withinthe Seventh Federal Judicial Circuit, and will faithfully adhere to them. I declare under penalty of perjury that the foregoing is true andcorrect.S/DateElectronic Signature of ApplicantApplicant222s NameLast NameFirst NameMiddle Name/InitialApplicant222s Law FirmApplicant222s AddressStreet AddressRoom/Suite Number CityStateZIP CodeWork Phone Number (The pro hac vice admission fee is $10.00 and shall be paid to the Clerk. No admission under Rule 83.14 is effective until such time as the fee has been paid.)NOTE:Attorneys seeking to appear pro hac vice may wish to consider filing a petition for admission to the general bar of this Court. The fee for admission to the General Bar is $1.00 The fee for pro hac vice admission is $10.00 Admission to the general bar permits an attorney to practice before this Court. Pro hac vice admission entitles an attorney to appear in a particular case only. Application for such admission must be made ineach case; and the admission fee must be paid in each case. . www.FormsWorkFlow.com