`
`U.S. District Court for the Northern District Of Illinois
`Attorney Appearance Form
`
`Case Title:
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`Case Number:
`
`An appearance is hereby filed by the undersigned as attorney for:
`
`Attorney name (type or print):
`
`Firm:
`
`
`
`Street address:
`
`City/State/Zip:
`
`
`
`Bar ID Number:
`(See item 3 in instructions)
`
`Email Address:
`
`Telephone Number:
`
`Are you acting as lead counsel in this case?
`
`Are you acting as local counsel in this case?
`
`Are you a member of the court’s trial bar?
`
`If this case reaches trial, will you act as the trial attorney?
`
` Yes
`
` Yes
`
` Yes
`
` Yes
`
` No
`
` No
`
` No
`
` No
`
`If this is a criminal case, check your status.
`
`Retained Counsel
`Appointed Counsel
`If appointed counsel, are you
`a Federal Defender
` CJA Panel Attorney
`______________________________________________________________________
`In order to appear before this Court an attorney must either be a member in good standing of this Court’s
`general bar or be granted leave to appear pro hac vice as provided for by local rules 83.12 through 83.14.
`I declare under penalty of perjury that the foregoing is true and correct. Under 28 U.S.C.§1746, this
`statement under perjury has the same force and effect as a sworn statement made under oath.
`
`Executed on
`
`Attorney signature: S/
`(Use electronic signature if the appearance form is filed electronically.)
`
`Revised 8/1/2015
`
`
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