UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF ...

Save As

Print

PETITION FOR ADMISSION

(Local General Rule 2)

UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MICHIGAN

Reset Form

Electronic 06/15

1. Name: ____________________________________________________________________

FIRST / MIDDLE / LAST

2. Firm Name: Business Address:

ROOM / SUITE / FLOOR / BUILDING

STREET ADDRESS

Business Telephone Number:

CITY/ STATE / ZIP

3. Identify all states (including the District of Columbia) in which you have been admitted to practice before the state's highest court, the date of admission, and whether you are in active status and good standing in that jurisdiction. If you are not in active status and good standing, explain on an attached sheet.

Jurisdiction

Date

Active Status & Bar Number

Good Standing?

1. _______________________ ____________

_______

__________

2. _______________________ ____________

_______

__________

3. _______________________ ____________

_______

__________

4. _______________________ ____________

_______

__________

5. _______________________ ____________

_______

__________

6. _______________________ ____________

_______

__________

4. Identify all federal courts (Supreme Court, Circuit Courts, District Courts, specialty courts) in which you have been admitted to practice, the date of admission, and status. If you are not in active status and good standing, explain on an attached sheet.

Court

1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 5. _______________________ 6. _______________________

Date

____________ ____________ ____________ ____________ ____________ ____________

Active Status & Good Standing?

_______ _______ _______ _______ _______ _______

Bar Number

__________ __________ __________ __________ __________ __________

5. Have you ever been held in contempt of court or otherwise subjected to discipline as defined by the Local Rules of the Western District of Michigan? If so, nature and disposition thereof:

6. Have you ever been convicted of any felony or misdemeanor? (You need not report a misdemeanor conviction occurring before commencement of law school.) If so, explain the facts and circumstances:

7. G I am newly admitted to the State Bar of

and request a waiver of the

sponsorship requirement. [One year or less from time of application.] No other waivers will

be granted except in extraordinary circumstances.

8. G I will make electronic payment of the $205.00 admission fee as instructed by the Clerk.

9. G I have read the Local Rules of the Western District of Michigan (miwd.).

10. G This application is continued on an attached page.

I swear (or affirm) that the above information is accurate and correct to the best of my knowledge and belief.

DATED

SIGNATURE OF APPLICANT

Statement of a sponsoring attorney of the Bar of this court, stating when the sponsoring attorney was admitted to practice in this court, under what circumstances the attorney has known the applicant, that the attorney knows the applicant to be of good character and reputation, and that the attorney believes the applicant to be well qualified as a member of the Bar of this court. For applicants residing in another state, the sponsor may be a judge of a court of record of that state, or a federal judge.

SPONSORING ATTORNEY'S NAME DATED

SIGNATURE OF SPONSORING ATTORNEY OR JUDGE STATE BAR I.D. NO.

Save As

Print

Reset Form

12/13

81,7('67$7(6',675,&7&2857 )257+(:(67(51',675,&72)0,&+,*$1

(),/,1*5(*,675$7,21)250

3OHDVHW\SHWKLVZ LOODOVRVHUYHDVDUHWXUQPDLOLQJODEHO

1DPH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB )LUP BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB $GGU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

3KRQHBBBBBBBBBBBBBBBBBBBB BB

6WDWH%DU1XPEHUBBBBBBBBBBBBBBBBBBBBBBB

D Q G V WD WH L I Q R W 0 L F K L J D Q

'DWHRIDGPLVVLRQWRWKH%DURIWKLVFRXUWBBBBBBB

127($3$&(5$&&2817,61(&(66$5< )259,(:,1*(/(&7521,&'2&80(176

7KLVIRUPFDQQRWEHVXEPLWWHGHOHFWURQLFDOO\ &RPSOHWHWKHIRUPRQOLQHSULQWDKDUGFRS\VLJQ VFDQDQGSUHVHQWLWWRWKH&OHUNDWWKHHPDLODGGUHVV EHORZ$ORJLQDQGSDVVZRUGIRUDFFHVVWRWKH HOHFWURQLFFDVHILOLQJV\VWHPZLOOEHLVVXHGWR\RX XSRQUHFHLSWRIWKHIXOO\FRPSOHWHGIRUP$OORIWKLV LQIRUPDWLRQLVUHTXLUHGDQGPXVWEHVXSSOLHG LQFOXGLQJ\RXURULJLQDOVLJQDWXUH

3ULPDU\HPDLODGGUHVVBBBBBBBBBBBBBBBBBBBBBB $WWRUQH\

VHP DLOIRUHOHFWURQLFVHUYLFH

6HFRQGDU\HPDLODGGUHVVBBBBBBBBBBBBBBBBBBBB

& H Q WUD OUH S R V LWR U\6 H F UH WD U\HWF

(PDLOVRIWZDUHXVHGBBBBBBBBBBBBBBBBBBBBBBB

LH2 XWORRN* URXSZLVHHWF

,KDYHDQH[LVWLQJ3$&(5DFFRXQW 0\ILUPKDVDQH[LVWLQJ3$&(5DFFRXQW

,DOUHDG\KDYHDQ(&)ORJLQWKDW,XVHLQBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBZKLFKLVBBBBBBBBBBBBB

1DP HRI2WKHU'LVWULFW

/RJLQ

SOHDVHDVVLJQWKHVDPHORJLQIRUP\XVHLQWKH:HVWHUQ'LVWULFWRI0LFKLJDQ

7KHLQIRUPDWLRQFRQWDLQHGLQWKLVER[ZLOOEHXVHGIRUVHFXULW\FRQILUPDWLRQSXUSRVHVUHODWHGWR\RXUHILOLQJORJLQSDVVZRUG

.H\ZRUGSKUDVHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB5HPLQGHUBCBBitByBBwBhBBeBrBeBByBoBuBBrBmBBoBBthBBeBrBwBBaBsBBbBoBBrBnBBBBBBBB

% ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download