IN THE CHANCERY COURT OF HAMILTON COUNTY, TENNESSEE



|IN THE CHANCERY COURT FOR HAMILTON COUNTY, |AFFIDAVIT OF MOVANT TO APPEAR |Part |

|TENNESSEE |PRO HAC VICE | |

| | |File N0. |

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|_____________________________________ |______________________________________ |

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|_____________________________________ |______________________________________ |

|Plaintiff(s) |Defendant(s) |

|STATE OF TENNESSEE |} | |

|COUNTY OF HAMILTON | |Pursuant to Rule 19(d), Tennessee Supreme Court Rules, Affiant , being duly |

| | |sworn, deposes and says: |

|1. Movant |

|1.1 My full name is |

|1.2 My residence address is |

|1.3 My office address is |

|1.4 The name(s) of the client(s) I seek to represent is/are |

|2. Jurisdictions I am now licensed in or have ever been previously licensed in are: |

|Jurisdiction |Admission Date |Bar Number |Good Standing |

| | | |( Yes ( No |

| | | |( Yes ( No |

| | | |( Yes ( No |

| | | |( Yes ( No |

|3. Within the preceding 3 years ( one |

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|3.1 ( I have not been admitted or sought admission pro hac vice in any trial or appellate court of Tennessee. |

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|3.2 ( I have been admitted or sought to be admitted pro hac vice in a trial or appellate court of Tennessee. The full name or style of each |

|case in which I have, the date of any such admission, or the date of any such motion that was filed but not granted, and the status of any |

|such case in which I was admitted, is: |

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|4. Prior admission pro hac vice ( one |

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|4.1 ( I have never been denied admission pro hac vice by any court in any jurisdiction. |

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|4.2 ( I have been denied admission pro hac vice. A full description of the matter, including the full name or style of the case is: |

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|5. Prior revocation of pro hac vice ( one |

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|5.3 ( I have never had an admission pro hac vice revoked by any court in any jurisdiction. |

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|5.4 ( I have had an admission pro hac vice revoked. A full description of the matter, including the full name or style of the case is: |

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|6. Prior disciplinary matters ( one |

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|6.1 ( I have never been disciplined or sanctioned by the Board of Professional Responsibility of the Supreme Court of Tennessee, by any |

|similar lawyer disciplinary agency in any jurisdiction, or by any similar lawyer disciplinary authority (including, for example, any United |

|States District Court). |

| |

|6.2 ( I have been disciplined or sanctioned by the Board of Professional Responsibility of the Supreme Court of Tennessee, or by a similar |

|lawyer disciplinary agency in another jurisdiction, or by a similar lawyer disciplinary authority (including, for example, any United States |

|District Court). A full description of the circumstances, including the full name or style of the matter is: |

| |

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|7. Pending disciplinary matters ( one |

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|7.1 ( There are no disciplinary actions or investigations concerning my conduct pending before the Board of Professional Responsibility of the|

|Supreme Court of Tennessee, before any similar lawyer disciplinary agency in any jurisdiction, or before any similar lawyer disciplinary |

|authority (including, for example, any United States District Court). |

| |

|7.2 ( There are disciplinary actions or investigations concerning my conduct pending before the Board of Professional Responsibility of the |

|Supreme Court of Tennessee, before a similar lawyer disciplinary agency in another jurisdiction, or before a similar lawyer disciplinary |

|authority (including, for example, any United States District Court). A full description of the circumstances, including the full name or |

|style of the matter is: |

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|8. Court Rules and conduct |

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|8.1 I am familiar with the Tennessee Rules of Professional Conduct and the rules governing the proceedings of this court. |

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|8.2 I consent to the disciplinary jurisdiction of the Board of Professional Responsibility of the Supreme Court of Tennessee and the courts of|

|Tennessee in any matter arising out of my conduct in this proceeding, and I agree to be bound by the Tennessee Rules of Professional Conduct |

|and any other rules of conduct applicable to lawyers generally admitted in Tennessee. |

|9. The lawyer with whom I am associated in accordance with Rule 19(g) is: |

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|9.1 Name |

|9.2 BPR # |

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|9.3 Address |

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|9.4 Telephone Number 9.5 Fax Number |

|10. Board of Professional Responsibility Fees |

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|10.1 I have paid all fees required by Tennessee Supreme Court Rule 19 in connection with this motion. |

|11. Other Information Supporting Affiant’s Admission (Optional) |

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|12. Certification |

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|12.1 I have duly served a copy of my MOTION TO APPEAR PRO HAC VICE and all exhibits upon all counsel of record in this proceeding and upon the|

|Board of Professional Responsibility of the Supreme Court of Tennessee. |

|Further, Affiant saith not. |

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|__________________________________________ |

|Affiant |

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|Sworn to and subscribed before me this _____ day of ___________, 20__. |

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|My Commission expires:__________________ |

|___________________________________ |

|Notary Public |

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