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STATE OF
WISCONSIN,
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Application for
Pro Hac Vice Admission
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I declare under penalty of perjury:
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1. That I seek to appear pro hac vice in order to represent
in the above-captioned matter;
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2. That I am admitted to practice law in the highest court(s) of
the state(s) or country(ies) of
;
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3. That there are no disciplinary complaints filed against me for
violation of the rules of those courts (if so, please explain):
;
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4. That I am not suspended or disbarred from practice for disciplinary
reasons or reason of medical incapacity in any jurisdiction (if yes, please explain):
;
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5. That I am associated with Attorney
,
State Bar No.
, an active member of the
State Bar of Wisconsin (name the member of the State Bar of Wisconsin and provide
his/her Member Number);
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6. That I do not practice or hold out to practice law in the State
of Wisconsin;
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7. That I acknowledge the jurisdiction of the courts of the State
of Wisconsin over my professional conduct, and I agree to abide by the rules of
the relevant division of the Circuit Court of the State of Wisconsin, the Wisconsin
Court of Appeals, the Wisconsin Supreme Court, and the Rules of Professional Conduct
for Attorneys, if I am admitted pro hac vice;
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8. That I have complied fully with SCR Rule 10.03 (4);
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9. That I am applying for admission pro hac vice for the following
reasons:
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I have applied for admission pro hac vice in the courts of the State of
Wisconsin
times previously in this calendar year.
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I attach here too evidence of my payment or prior payment of the pro hac vice fee.
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Signature of Attorney
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Telephone Number
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Name Printed
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Email Address (if any)
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Address of Principal Office
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Country:
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