Petition For Admittance To Practice

Admission Fee: $281.00 To be submitted with petition. Firm Name Address City, State, Zip State Bar. No. Telephone E-mail Facsimile IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ALASKA In the matter of Petition for Admittance to Practice Before the United States District Court for the District of Alaska do hereby petition the Honorable Judges of this Court I, for admission to practice before the United States District Court for the District of Alaska. Signature of Applicant Residence Address Social Security Number City, State, Zip G I have not been known by any other name. G See attachment for other name(s) by which I have been known. G I am not admitted to practice before any court other than the courts of the State of Alaska. G I am admitted to practice before the court(s) listed on the attachment hereto. G I am not presently, nor have I ever been, the subject of a disciplinary action in any court to which I am, or have been, admitted to practice. G I have been the subject of disciplinary action in a court to which I have been admitted to practice as set forth on the attachment hereto. Attached is an original certificate of good standing proving that the applicant has the requisite qualifications to practice as an attorney and counselor at law in the courts of the State of Alaska. Also attached is proof of service of this petition on the Alaska Bar Association. ORDER The above named petitioner is hereby Ordered admitted to practice before the United States District Court for the District of Alaska upon taking the prescribed oath. DATED: Timothy M. Burgess, Chief Judge United States District Court American LegalNet, Inc. www.FormsWorkFlow.com Proof of Service , a copy of the Petition for Admittance I hereby certify that on to Practice Before the United States District Court for the District of Alaska was served by first class mail, postage prepaid, on the Executive Director of the Alaska Bar Association, P.O. Box 100279, Anchorage, Alaska 99510-0279. Signature American LegalNet, Inc. www.FormsWorkFlow.com Attachment to Petition for Admittance to Practice Before U.S. District Court, Alaska Admitted to Practice Before the Following Courts: Name of Court Address City, State, Zip Date Admitted Name of Court Address City, State, Zip Date Admitted Name of Court Address City, State, Zip Date Admitted Name of Court Address City, State, Zip Date Admitted Name of Court Address City, State, Zip Date Admitted Name of Court Address City, State, Zip Date Admitted Disciplinary Actions: Court: Date: Nature of Action: Court: Date: Nature of Action: Disposition: G Copy of Disciplinary Action attached Other Names: Name: Dates Used: Reason for Change: Disposition: G Copy of Disciplinary Action attached Name: Dates Used: Reason for Change: American LegalNet, Inc. www.FormsWorkFlow.com