UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF LOUISIANA
DIVISION
Case No.
Plaintiff
VS.	Judge
Magistrate Judge
Defendant
MOTION TO APPEAR PRO HAC VICE

In accordance with the local rules for the United States District Court, Western District
of Louisiana, application is made to be admitted pro hac vice to the bar of this court for the
purpose of appearing on behalf of
in the above described action.
•	I am ineligible to become a member of this court, but I am a member in good standing
of the bar of the United States District Court for the District of
or the bar of	court, which is the highest court of such state.
Attached hereto is a certificate of good standing from such court.
•	Payment of the applicable fee of $105.00 is made via the court's electronic filing system using Pay.gov.
•	There have been no disciplinary proceedings or criminal charges instituted against me.
•	In accordance with the local rules for the United States District Court, Western District
of Louisiana,	of the firm of
is appointed a local counsel.
•	I authorize the Clerk of Court for the Western District of Louisiana to transmit notice of entries of judgments and orders to me under Fed.R.Civ.P. 77, Fed.R.Cr.P. 49, LR 5.7.10. I also agree to receive notice electronically from other parties and the court via electronic mail. I understand that electronic mail filter software (SPAM filter) may interfere with receipt of e-mail notices and have verified that any such software installed on my computer or network will not filter our messages sent from Clerk@lawd.uscourts.gov. I understand this electronic notice will be in lieu of notice by any other means. I understand it is my responsibility to advise the Clerk's Office promptly in writing of any physical address changes and/or update my electronic mail address within the court's electronic filing system.
Respectfully submitted,
Signature of Applying Attorney	Signature of Local Counsel
Applying attorney must sign. No "s/ signature" accepted.

Local counsel may use typed "s/ signature" and must file electronically.
PLEASE TYPE OR PRINT LEGIBLY:	LOCAL COUNSEL INFORMATION:
Name:	Name:
Firm:	Firm:
Address:	Address:
Telephone:	Telephone:
Fax:	Fax:
E-mail:	E-mail:
Additional e-mail(s):
Certificate of Service
I hereby certify that on	, I presented the foregoing Petition for
Admission Pro Hac Vice to the Clerk of Court for filing and uploading to the CM/ECF system
which will send notification of such filing to the following:
,
and I hereby certify that I have mailed by United States Postal Service this filing to the
following non-CM/ECF participants:
.
Signature
Name:
Firm:
Address:
Telephone:
Fax:
E-mail:
UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF LOUISIANA
DIVISION
Case No.
Plaintiff
VS.	Judge
Magistrate Judge
Defendant
ORDER

IT IS ORDERED that	be and is hereby
admitted to the bar of this Court pro hac vice on behalf of
in the above described action.
SO ORDERED on this, the	day of	,	.
U.S. Magistrate Judge