______________________________________ 

 

 

 

 

 

 

 

 

 

 

 

 


 


 


 


 

UNITED STATES DISTRICT COURT
 

DISTRICT OF OREGON
 

Civil Case No. ______________ 

____ 

v. 

_____________________________ 

Plaintiff(s), 

_____ APPLICATION FOR SPECIAL 

ADMISSION – PRO HAC VICE 

Defendant(s). 

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) 

Firm or Business Affiliation: 

(First Name) (MI) (Suffix) 

Mailing Address: 

City: 

Phone Number: 

State: 

 Fax Number: 

Zip: 

Business E-mail Address: 

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

Revised March 1, 2014 Page 1 of 3 

Case 3:16-cv-00483-SI Document 24 Filed 03/25/16 Page 1 of 5
 

 

 

 

 

 

 

 

 

	 

	 

	 

	 

	 

	 

	 

	 

(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: 

I have professional liability insurance, or financial responsibility equivalent to liability 

insurance, 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: 

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

Revised March 1, 2014	 Page 2 of 3 

Case 3:16-cv-00483-SI Document 24 Filed 03/25/16 Page 2 of 5
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

(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) 

Oregon State Bar Number: 

Firm or Business Affiliation: 

(First Name) (MI) (Suffix) 

Mailing Address: 

City: 

Phone Number: 

State: 

Business E-mail Address: 

Zip: 

COURT ACTION
 

☐ Application approved subject to payment of fees. 

☐ Application denied. 

DATED this day of , 

Judge 

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

Revised March 1, 2014 Page 3 of 3 

Case 3:16-cv-00483-SI Document 24 Filed 03/25/16 Page 3 of 5
KE 40581162.1

Exhibit A

Court Number (If Applicable) Date of Admission

United States Supreme Court 1/19/1993

United States District Court 

For The District of Columbia

449280 12/2/1996

United States Court Of 

Appeals For The First Circuit

10/1/2015

United States Court Of 

Appeals For The Second 

Circuit

2/23/1996

United States Court Of 

Appeals For The Third Circuit

6/29/2012

United States Court Of 

Appeals For The Fourth 

Circuit

2/14/1992

United States Court Of 

Appeals For The Fifth Circuit

8/9/2007

United States Court Of 

Appeals For The Sixth Circuit

11/13/2013

United States Court Of 

Appeals For The Seventh 

Circuit

11/6/2015

United States Court Of 

Appeals For The Eighth 

Circuit

4/19/1999

United States Court Of 

Appeals For The Ninth Circuit

2/14/2001

United States Court Of 

Appeals For The Tenth Circuit

4/15/2010

United States Court Of 

Appeals For The Eleventh 

Circuit

12/13/2006

Case 3:16-cv-00483-SI Document 24 Filed 03/25/16 Page 4 of 5
2

KE 40581162.1

United States Court Of 

Appeals For The Federal 

Circuit

12/9/2011

United States Court Of 

Appeals For The DC Circuit

46874 6/14/2000

United States Tax Court LJ 1041 5/2/2006

United States District Court 

For The Southern District of 

New York

JL 7062 8/8/1989

United States District Court 

For The Eastern District of 

New York

JL 7062 1/1/2009

United States District Court 

For The Eastern District of 

Michigan

8/26/1994

United States District Court 

For The Eastern District of 

Wisconsin

2/7/1997

United States District Court 

For The District of Colorado

5/21/2007

New York State Court 2192425 3/21/1988

District of Columbia Court of 

Appeals

449280 2/5/1996

Case 3:16-cv-00483-SI Document 24 Filed 03/25/16 Page 5 of 5