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UNITED STATES DISTRICT COURT
DISTRICT OF NEVADA
) Case #_______________________
)
)
) VERIFIED PETITION FOR
Plaintiff(s), ) PERMISSION TO PRACTICE
) IN THIS CASE ONLY BY
vs. ) ATTORNEY NOT ADMITTED
) TO THE BAR OF THIS COURT
) AND DESIGNATION OF
) LOCAL COUNSEL
)
Defendant(s). )
____________________________________) FILING FEE IS $250.00
____________________________, Petitioner, respectfully represents to the Court:
(name of petitioner)
1. That Petitioner is an attorney at law and a member of the law firm of
_______________________________________________________________________________
(firm name)
with offices at __________________________________________________________________,
(street address)
____________________________________, ____________________________, ____________,
(city) (state) (zip code)
_____________________________, ___________________________________.
(area code + telephone number)
(Email address)
2. That Petitioner has been retained personally or as a member of the law firm by
_______________________________________ to provide legal representation in connection with
[client(s)]
the above-entitled case now pending before this Court.
Rev. 5/16
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3. That since _______________________, Petitioner has been and presently is a
(date)
member in good standing of the bar of the highest Court of the State of ______________________
(state)
where Petitioner regularly practices law. Petitioner shall attach a certificate from the state bar or
from the clerk of the supreme court or highest admitting court of each state, territory, or insular
possession of the United States in which the applicant has been admitted to practice law certifying
the applicant's membership therein is in good standing.
4. That Petitioner was admitted to practice before the following United States District
Courts, United States Circuit Courts of Appeal, the Supreme Court of the United States and Courts
of other States on the dates indicated for each, and that Petitioner is presently a member in good
standing of the bars of said Courts.
Court Date Admitted Bar Number
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
_________________________________________ _________________ ___________________
5. That there are or have been no disciplinary proceedings instituted against petitioner,
nor any suspension of any license, certificate or privilege to appear before any judicial, regulatory
or administrative body, or any resignation or termination in order to avoid disciplinary or
disbarment proceedings, except as described in detail below:
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(State “none” if Petitioner has no disciplinary proceedings, etc.)
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6. That Petitioner has never been denied admission to the State Bar of Nevada. (Give
particulars if ever denied admission):
7. That Petitioner is a member of good standing in the following Bar Associations.
8. Petitioner has filed application(s) to appear as counsel under Local Rule IA 11-2
(formerly LR IA 10-2) during the past three (3) years in the following matters: (State "none" if no applications.)
Date of Application Cause Title of Court Was Application
Administrative Body Granted or
or Arbitrator Denied
___________________ __________________ _________________________ _______________
___________________ __________________ _________________________ _______________
___________________ __________________ _________________________ _______________
___________________ __________________ _________________________ _______________
___________________ __________________ _________________________ _______________
(If necessary, please attach a statement of additional applications)
9. Petitioner consents to the jurisdiction of the courts and disciplinary boards of the
State of Nevada with respect to the law of this state governing the conduct of attorneys to the same
extent as a member of the State Bar of Nevada.
10. Petitioner agrees to comply with the standards of professional conduct required of
the members of the bar of this court.
11. Petitioner has disclosed in writing to the client that the applicant is not admitted to
practice in this jurisdiction and that the client has consented to such representation.
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(State “none” if Petitioner has never been denied admission.)
(State “none” if Petitioner is not a member of other Bar Associations.)
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That Petitioner respectfully prays that Petitioner be admitted to practice before this Court
FOR THE PURPOSES OF THIS CASE ONLY.
___________________________________________
Petitioner’s signature
STATE OF __________________ )
)
COUNTY OF _________________ )
_______________________, Petitioner, being first duly sworn, deposes and says:
That the foregoing statements are true.
___________________________________________
Petitioner’s signature
Subscribed and sworn to before me this
__________day of_____________________, ____________.
_________________________________________________
Notary Public or Clerk of Court
DESIGNATION OF RESIDENT ATTORNEY ADMITTED TO
THE BAR OF THIS COURT AND CONSENT THERETO.
Pursuant to the requirements of the Local Rules of Practice for this Court, the Petitioner
believes it to be in the best interests of the client(s) to designate _________________________,
(name of local counsel)
Attorney at Law, member of the State of Nevada and previously admitted to practice before the
above-entitled Court as associate resident counsel in this action. The address and email address of
said designated Nevada counsel is:
______________________________________________________________________________,
(street address)
____________________________________, ____________________________, ____________,
(city) (state) (zip code)
_____________________________, ___________________________________.
(area code + telephone number) (Email address)
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17 CONSENT OF DESIGNEE
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By this designation the petitioner and undersigned party(ies) agree that this designation constitutes
agreement and authorization for the designated resident admitted counsel to sign stipulations
binding on all of us.
APPOINTMENT OF DESIGNATED RESIDENT NEVADA COUNSEL
The undersigned party(ies) appoint(s) _____________________________________ as
(name of local counsel)
his/her/their Designated Resident Nevada Counsel in this case.
________________________________________________
(party's signature)
________________________________________________
(type or print party name, title)
________________________________________________
(party's signature)
(type or print party name, title)
The undersigned hereby consents to serve as associate resident Nevada counsel in this case.
________________________________________________
Designated Resident Nevada Counsel’s signature
Bar number Email address
APPROVED:
Dated: this ______ day of ________________, 20___.
____________________________________________
UNITED STATES DISTRICT JUDGE
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