U.S. District Court–Oregon Application for Special Admission - Pro Hac Vice

Revised March 28, 2016 Page 1 of 3 

UNITED STATES DISTRICT COURT

DISTRICT OF OREGON

______________________________________ 

Plaintiff(s),

v.

______________________________________ 

Defendant(s).

Civil Case No. ____________

APPLICATION FOR SPECIAL 

ADMISSION – PRO HAC VICE

 Attorney requests special admission pro hac vice in 

the above-captioned case. 

Certification of Attorney Seeking Pro Hac Vice Admission: I have read and understand the 

requirements of LR 83-3, and certify that the following information is correct: 

(1) PERSONAL DATA:

Name: 

(Last Name) (First Name) (MI) (Suffix) 

Firm or Business Affiliation: 

Mailing Address: 

City: State: Zip: 

Phone Number: Fax Number: 

Business E-mail Address: 

3:14-cv-00706-YY

KERRY D. AUSTIN, on behalf of himself and

all others similarly situated

UNION BOND & TRUST CO., et al.

James A. Bloom

Bloom James A.

Schneider Wallace Cottrell Konecky Wotkyns LLP

Emeryville

(415) 421-7100

2000 Powell Street, Suite 1400

94608

(415) 421-7105

California

jbloom@schneiderwallace.com

Case 3:14-cv-00706-YY Document 148 Filed 10/20/16 Page 1 of 3
U.S. District Court–Oregon Application for Special Admission - Pro Hac Vice

Revised March 28, 2016 Page 2 of 3 

(2) BAR ADMISSIONS INFORMATION:

(a) State bar admission(s), date(s) of admission, and bar ID number(s): 

(b) Other federal court admission(s), date(s) of admission, and bar ID number(s): 

(3) CERTIFICATION OF DISCIPLINARY ACTIONS:

(a) ܆ I am not now, nor have I ever been subject to any disciplinary action by any 

state or federal bar association; or 

(b) ܆ I am now or have been subject to disciplinary action from a state or federal bar 

association. (See attached letter of explanation.)

(4) CERTIFICATION OF PROFESSIONAL LIABILITY INSURANCE:

Per LR 833(a)(3), I have professional liability insurance, or financial responsibility

equivalent to liability insurance, that meets the insurance requirements of the Oregon

State Bar for attorneys practicing in this District, and that will apply and remain in force 

for the duration of the case, including any appeal proceedings. 

(5) REPRESENTATION STATEMENT:

I am representing the following party(s) in this case:

Arizona - December 9, 2008 - SBN 026643

District of Arizona - February 12, 2009

✔

Plaintiff Kerry D. Austin, on behalf of himself and all others similarly situated

Case 3:14-cv-00706-YY Document 148 Filed 10/20/16 Page 2 of 3
U.S. District Court–Oregon Application for Special Admission - Pro Hac Vice

Revised March 28, 2016 Page 3 of 3 

(6) CM/ECF REGISTRATION: 

Concurrent with approval of this pro hac vice application, I acknowledge that I will 

become a registered user of the Court’s Case Management/Electronic Case File system. 

(See the Court's website at ord.uscourts.gov), and I consent to electronic service pursuant 

to Fed. R. Civ. P 5(b)(2)(E) and the Local Rules of the District of Oregon. 

DATED this day of , 

 

(Signature of Pro Hac Counsel)

 

(Typed Name) 

CERTIFICATION OF ASSOCIATED LOCAL COUNSEL: 

I certify that I am a member in good standing of the bar of this Court, that I have read and understand the 

requirements of LR 83-3, and that I will serve as designated local counsel in this particular case.

DATED this day of , 

 

(Signature of Local Counsel)

Name: 

(Last Name) (First Name) (MI) (Suffix) 

Oregon State Bar Number: 

Firm or Business Affiliation: 

Mailing Address: 

City: State: Zip: 

Phone Number: Business E-mail Address: 

COURT ACTION

܆ Application approved subject to payment of fees. 

܆ Application denied. 

DATED this day of , 

 

 Judge

s/Timothy DeJong 

/s/James A. Bloom

19th October 2016

James A. Bloom

20th October 2016

DeJong Timothy S.

940662

Stoll Stoll Berne Lokting & Shlachter P.C.

Portland

(503) 227-1600

209 S. W. Oak Street, Suite 500

Oregon 97204

tdejong@stollberne.com

Case 3:14-cv-00706-YY Document 148 Filed 10/20/16 Page 3 of 3