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UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH <br /> <br />Plaintiff <br />v. <br />• CASE NO. <br />Appearing on behalf of: <br />(PlaintifF/Defendant) <br />Defendant. ' <br />MOTION AND CONSENT OF DESIGNATED ASSOCIATE LOCAL COUNSEL <br />I, ,hereby move the pro hac vice admission of petitioner to <br />practice in this Court. I hereby agree to serve az designated local counsel for the subject case; to readily <br />communicate with opposing counsel and the Court regarding the conduct of this case; and to accept papers when <br />served and recognize my responsibility and full authority to act for and on behalf of the client in all case-related <br />proceedings, including hearings, pretrial conferences, and trials, should Petitioner fail to respond to any Court order. <br />This day of , 19 <br />(Utah Bar Number) (Signature of Local Counsel) <br />APPLICATION FOR ADMISSION PRO HAC VICE <br />Petitioner, ,hereby requests permission to appear pro hac <br />vice in the subject case. Petitioner states under penalty of perjury that (he/she) is a member in good standing of the <br />bar of a United States court or o[ the highest court of a state, is anon-resident of the State of Utah, and under the <br />provisions of Rule 103-1(d) of the Rules of Practice of this Court haz associated local counsel in this matter. <br />Petitioner's residence address, office address, and office telephone number, the courts to which admitted, and the <br />respective dates of admission are provided az required. <br />Petitioner designates <br />This day of , 19 <br />az associate local couttsel. <br />(Signature of Petitioner) <br />ORDER OF ADMISSION <br />It appearing to the Court that Petitioner meets the pro hac vice admission requirements of Rule 103-1(b), <br />the motion for Petitioner's admission pro hac vice in the United States District Court, District of Utah in the subject <br />case is GRANTED. <br />This day of , 19 <br />U.S. District ]udge <br />(OVER) <br />