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Application And Oath For Admission (Fifth Circuit COA) DKT-5B - Official Federal Forms
| Application And Oath For Admission (Fifth Circuit COA) Form. This is a national form and can be used in 5th Circuit Court Of Appeals Circuit Court Of Appeals . |
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APPLICATION AND OATH FOR ADMISSION U. S. COURT OF APPEALS FOR THE FIFTH CIRCUIT, 600 S. Maestri Place, New Orleans, LA 70130 PERSONAL STATEMENT Name (Last) Firm or Agency Street Address City & State Phone ( ) Fax ( ) Zip Cell Phone ( Date of Birth Suite Social Security No. )__________________________ Sex: (First) (Middle) E-Mail Address List State Bars to which admitted, and State Bar Numbers qM qF Pursuant to FED. R. APP. P. 46(a), you must be a member in good standing of a federal or state court/bar. Please attach a certificate of good standing from a qualifying court. NOTE, a certificate of good standing is not required if you were initially admitted to a state bar or state supreme court within 30 days of this application or if you are currently an attorney employed by the United States Government and appearing on behalf of the United States. If admitted to state bar or state supreme court within the last 30 days, please identify below: State Bar or State Supreme Court: Date Admitted Please answer the following questions. Yes No q q 1. Have you ever been known by any name other than the one appearing on this application? If so, attach a list of all other names used. q q 2. Have you been disbarred, suspended from practice or received a reprimand pertaining to your conduct or fitness to practice law from any court, department, bureau or commission of any State or the United States? Are any such proceedings or allegations pending against you? If so, attach a detailed explanation containing dates and circumstances. q q 3. Are you presently under investigation, or have you been a party to criminal, or civil proceedings alleging fraud, misrepresentation or other dishonesty? If so, attach a detailed explanation. ADMISSION FEE: The $226.00 admission fee is to be paid by check payable to "Clerk, United States Court." If claiming a fee exemption under 5th Cir. R. 46.1, mark as appropriate: q Court Apptd. q U.S. Counsel q Newly Graduated Military Attorney1 CASE NUMBER in Fifth Circuit (If Any), OATH (OR AFFIRMATION): I, do solemnly swear or affirm that I will conduct myself as an attorney and counselor of this court, uprightly and according to law; and that I will support the Constitution of the United States. I further swear or affirm all responses in my personal statement, including any attachments thereto, are true and correct to the best of my knowledge, information and belief. I also acknowledge that my admission will be for five years and that I must renew my membership at the expiration of the five-year period. Signature of Applicant Subscribed and sworn to before me a Notary Public in and for the of , State of this day of . Signature of Notary MOTION: I, (Please print or type) Signature Admitted this day of . By Deputy Clerk U.S. Court of Appeals 1 a member of the Bar of this Court, move the above attorney's admission. Please see attached note. DKT-5B(02/12) American LegalNet, Inc. www.FormsWorkFlow.com Note Regarding Newly Graduated Military Attorney Status: 5th CIR. R. 46.1 waives admission fees for newly graduated lawyers admitted to practice in Louisiana, Mississippi, and Texas on initial extended active duty orders for service in the Judge Advocate General's Corps of the Armed Forces. To claim an exemption please: 1) 2) 3) 4) Mark the Newly Graduated Military Attorney box; Provide a paper or electronic copy of your law school transcript, or other document from you school showing your graduation date; Provide a paper or electronic copy of your orders directing you to report for extended active duty with the Judge Advocate General's Corps; Provide documentation of bar admission. If you have questions call 504-310-7700. American LegalNet, Inc. www.FormsWorkFlow.com
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