Ala. R. Bar Admis. Verified Application for Admission to Practice Under Rule VII of the Rules Governing Admission to the Alabama State Bar for Pro Bono Counsel

IN THE ________________ COURT

_________________________

Petitioner/Appellant,

v. Case No.___________________

______________________________,

Respondent/Appellee

VERIFIED APPLICATION FOR ADMISSION TO PRACTICE UNDER RULE VII OF THE RULES

GOVERNING ADMISSION TO THE ALABAMA STATE BAR FOR PRO BONO COUNSEL

Comes now ___________________________________, applicant herein, and respectfully represents the following:

1. Applicant resides at:

Street Address: ______________________________________________________________

City, State, Zip: ______________________________________________________________

Telephone No.: ______________________________________________________________

Social Security No.: __________________________________________________________

2. Applicant is an attorney and a member of the law firm of (or practices law under the name of):

_________________________________________________________________

Street Address: _________________________

City, State, Zip: _______________________

Telephone No.: __________________________

3. Applicant has agreed to provide pro bono legal representation to _____________________ (client's name),

who is indigent, in the above-styled matter now pending before this court. Applicant will not charge an

attorney fee to the client.

4. Since __________________ (date of admission), applicant has been and presently is a member in good

standing of the Bar of the highest court of the State of ______________________, where applicant regularly

practices law.

ATTACH CERTIFICATE OF GOOD STANDING ISSUED WITHIN PREVIOUS 60 DAYS BY THE

BAR OF THE HIGHEST STATE COURT OF THE JURISDICTION WHERE APPLICANT

REGULARLY PRACTICES LAW.

5. Applicant has been admitted to practice before the following courts and is presently a member in good

standing of the Bars of those courts, except as specified below.

LIST ALL UNITED STATES DISTRICT COURTS, UNITED STATES CIRCUIT COURTS OF

APPEALS, SUPREME COURT OF THE UNITED STATES, AND STATE COURTS. NOTE ANY

COURT IN WHICH APPLICANT IS NO LONGER ADMITTED TO PRACTICE.

Court: Date Admitted:

6. Applicant presently is not subject to any disbarment or suspension proceedings, except as provided below

(give particulars, e.g., jurisdiction, court, date):

7. Applicant never has been subject to any disbarment or suspension proceedings, or had any certificate or

privilege to appear or practice before any administrative body suspended or revoked, except as provided

below (give particulars, e.g., jurisdictions, date of proceedings, court or administrative body, date of

reinstatement):

8. Applicant, either by resignation, withdrawal, or otherwise, never has terminated or attempted to terminate

applicant's office as an attorney in order to avoid administrative, disciplinary, disbarment, or suspension

proceedings.

9. The following list states accurately the name and address of each counsel of record who has appeared for

each party and name and address of each party in this matter not represented by counsel:

Name of Party/Counsel Mailing Address

10. Applicant agrees to comply with the provisions of the Alabama Rules of Professional Conduct, and applicant

consents to the jurisdiction of the courts and the disciplinary boards of the State of Alabama.

11. Applicant respectfully requests to be admitted to practice in the above-named court for this cause only.

DATED this the ___ day of __________, 20___.

______________________________________

APPLICANT

STATE OF _____________________________

COUNTY OF ___________________________

I, ______________________________________, do hereby swear or affirm under penalty of perjury that I am the

applicant in the above-styled matter; that I have read the foregoing application and know the contents thereof, and

that the contents are true of my own knowledge, except as to those matters stated on information and belief, and that

as to those matters I believe them to be true.

______________________________________

APPLICANT/AFFIANT

Subscribed and sworn to before me this ___________ day of ________________________________, 20______.

______________________________________

NOTARY PUBLIC

My commission expires: ___________________

CERTIFICATE OF SERVICE

I hereby certify that I have served a copy of this application upon the Alabama State Bar by mail addressed to

Alabama State Bar, Attention: PHV Admissions, P.O. Box 671, Montgomery, Alabama, 36101 on this _______ day

of ______________________, 20 _________.

____________________________________

APPLICANT

(Form approved by Alabama State Bar and Alabama Supreme Court eff. 1-1-1994; Amended eff. 9-19-2006.)