Form 3 Record Of Civil Actions

APPLICATION FOR ADMISSION PRO HAC VICE Name: Firm Name: Address: City, State, Zip: Telephone / Fax: E - mail (if any): State(s) to Which Admitted Bar Number Case in which Applicant wishes to appear: Case Name Court Case Number Party on whose behalf Applicant seeks to appear appeared pro hac v ice in the previous five years (Attach additional sheets if necessary) Case Name Case Number Court Are you (the Applicant) currently suspended or disbarred from the practice of l aw in any state? If yes, please explain: American LegalNet, Inc. www.FormsWorkFlow.com If yes, please explain: Are you (the Applicant) the subject of any pending disciplinary proceeding organization? Sponsoring Local Counsel: (must be Utah resident) Name: Utah Bar Number: Address: City, State, Zip: Telephone / Fax: E - mail (if any): Applicant certi fies the following: Applicant submits to the disciplinary authority and procedures of the Utah State Bar. Applicant is familiar with the rules of procedure and evidence, including applicable local rules. Applicant will be available for deposition s, hearings and conferences. Applicant will comply with the rulings and orders of the court. All the information included in this application is accurate. Applicant must attach to this application an original Certificate of Good Standing form the li censing state which the applicant resides (Applicants may not reside in Utah). STATE OF ) :ss COUNTY OF ) Signed and sworn to before me on by Notary Public My appointment expires: American LegalNet, Inc. www.FormsWorkFlow.com