`
`UNITED STATES DISTRICT COURT
`CENTRAL DISTRICT OF CALIFORNIA
`CASE NUMBER
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`v.
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`Plaintiff(s)
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`Defendant(s).
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`APPLICATION OF NON-RESIDENT
`ATTORNEY TO APPEAR IN A SPECIFIC CASE
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`NOTICE: Effective November 1, 2011, the fee for Pro Hac Vice Appearance is $325.00 for each case application. Please
`submit the fee with your application, if you are efiling the application attach a copy of your receipt. Pursuant to
`Local Rule 83-2.4, submission of this application and the fee is waived for attorneys for the United States, its
`departments and agencies with Appointment Affidavits on file with the Clerk. If no Appointment Affidavit is
`on file, submission of the application is required. The Pro Hac Vice appearance fee must be paid in full before
`any appearance will be permitted. Proof of payment receipt must be attached to this application.
`
`A CERTIFICATE OF GOOD STANDING for the applicant from the state in which the applicant is a member of the bar, and which
`has been issued within 30 days, must be attached to this application.
`
` , hereby apply to the Court under Local Rules 83-2.3 and
`I,
`83-2.8.2 for permission to appear and participate in the above-entitled action on behalf of G Plaintiff G Defendant:
` by whom I have been retained.
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`My business information is:
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`Firm Name
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`Street Address
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`City, State, Zip
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` E-Mail Address
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`Telephone Number
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` Fax Number
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`I am a member in good standing and eligible to practice before the following courts. List all that apply. Attach additional
`pages if necessary.
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`Title of Court
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`Date of Admission
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`G–64 (11/11)
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`APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE
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`PAGE 1 of 2
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`
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`Case 8:11-cv-01985-CJC-RNB Document 6-1 Filed 12/28/11 Page 2 of 2 Page ID #:379
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`I am not a resident of the State of California. I am not regularly employed in, or engaged in substantial business, professional,
`or other activities in the State of California. I am not currently suspended from, and I have never been disbarred from practice
`in any court.
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`I have concurrently, and within three (3) years of this application, made Pro Hac Vice applications to this Court in the
`following actions. List all that apply. Attach additional pages if necessary.
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`Case Number
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` Ttitle of Action
`
`
`
` Date of Application
`
`
` Application
`Granted or Denied
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`
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`
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`If any Pro Hac Vice applications submitted within three (3) years of this application have been denied by the Court,
`please explain:
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`I designate
`
` as local counsel, whose business information is as follows:
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`Firm Name
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`Street Address
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`City, State, Zip
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`E-Mail Address
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`Telephone Number
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` Fax Number
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`who is a member in good standing of the Bar of this Court and maintains an office in the Central District of California for the
`practice of law, as the attorney with whom the Court and opposing counsel may readily communicate regarding the conduct
`of this case, and upon whom papers may be served.
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`I declare under penalty of perjury that the foregoing is true and correct and that I am familiar with the Local Rules, the Local
`Criminal Rules, the F.R. Civ. P., the F.R. Crim. P., and the F.R. Evidence. I also consent to electronic service.
`
`Dated
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`Applicant’s Name (please print)
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`Applicant’s Signature
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`I hereby consent to the foregoing designation as local counsel and I consent to electronic service.
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`Dated
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`Designee’s Name (please print)
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`Designee’s Signature
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`Designee’s California State Bar Number
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`NOTE: COUNSEL AND PARTIES ARE REMINDED TO SUBMIT A COMPLETED ORDER ON APPLICATION OF NON-
`RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE (G-64 ORDER) ALONG WITH THIS APPLICATION.
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`G–64 (11/11)
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`APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE
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`PAGE 2 of 2