"Pro Hac Vice Admission Registration Statement" - North Carolina

Pro Hac Vice Admission Registration Statement is a legal document that was released by the North Carolina State Bar - a government authority operating within North Carolina.

Form Details:

  • Released on April 4, 2018;
  • The latest edition currently provided by the North Carolina State Bar;
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  • Fill out the form in our online filing application.

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Post Office Box 25908
Raleigh, North Carolina 27611
Telephone: (919) 828-4620
Web: www.ncbar.gov
INSTRUCTIONS FOR COMPLETING
PRO HAC VICE ADMISSION REGISTRATION STATEMENT
Filed by the North Carolina Responsible Attorney
Rev. 4/4/18
 Complete and mail the registration form to the North Carolina State Bar at the address listed
above within 30 days of the entry of the pro hac vice admission order.
 Registration is required in conjunction with pro hac vice admission to a North Carolina
tribunal. See G.S. 84-4.1 (5). Registration is not required for pro hac vice admission to a
federal court, but is required for pro hac vice admission to the NC Court of Appeals and the
NC Supreme Court.
 Registration is not required for any pro hac vice admission order entered prior to March 2,
2006.
 Copy of Order: Enclose a copy of the pro hac vice admission order with the registration form.
(no staples please)
 Statement of Tax Reporting (Item 5 on the Registration Statement): Attach a signed
statement (original or photocopy will be acceptable) from the out of state attorney confirming
that he or she will report income to the North Carolina Department of Revenue if required to
do so by law. The out of state attorney must determine whether the income is reportable and
whether and when to file a tax return.
Suggested wording for the statement: “Regarding the matters identified in items 3 & 4 of the
Pro Hac Vice Registration Statement, I, [out of state attorney’s name], verify that I will report
any income earned to the North Carolina Department of Revenue if required to do so by law.”
(Please list the case caption above the signed statement.)
 Payment Information: Confirm that the out of state attorney has paid the $25 fee owed to the
North Carolina State Bar pursuant to G.S. 84-4.1(7).
o When filing a pro hac vice motion with a district or superior court of the North
Carolina General Courts of Justice, a fee of $225 should be collected by the clerk of
court in the county. The clerk will remit $25 of this fee to the Administrative Office of
the Courts for ultimate transmission to the State Bar in satisfaction of the payment
required by G.S. 84-4.1(7). Payment to the clerk may be documented with a receipt or
by providing the check number and date of the check.
o When a pro hac vice motion is filed with the NC Court of Appeals, a fee of $225
should be collected by the clerk. The clerk will remit $25 of this fee to the
Administrative Office of the Courts for ultimate transmission to the State Bar in
satisfaction of the payment required by G.S. 84-4.1(7). Payment to the clerk may be
documented with a receipt or by providing the check number and date of the check.
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Post Office Box 25908
Raleigh, North Carolina 27611
Telephone: (919) 828-4620
Web: www.ncbar.gov
INSTRUCTIONS FOR COMPLETING
PRO HAC VICE ADMISSION REGISTRATION STATEMENT
Filed by the North Carolina Responsible Attorney
Rev. 4/4/18
 Complete and mail the registration form to the North Carolina State Bar at the address listed
above within 30 days of the entry of the pro hac vice admission order.
 Registration is required in conjunction with pro hac vice admission to a North Carolina
tribunal. See G.S. 84-4.1 (5). Registration is not required for pro hac vice admission to a
federal court, but is required for pro hac vice admission to the NC Court of Appeals and the
NC Supreme Court.
 Registration is not required for any pro hac vice admission order entered prior to March 2,
2006.
 Copy of Order: Enclose a copy of the pro hac vice admission order with the registration form.
(no staples please)
 Statement of Tax Reporting (Item 5 on the Registration Statement): Attach a signed
statement (original or photocopy will be acceptable) from the out of state attorney confirming
that he or she will report income to the North Carolina Department of Revenue if required to
do so by law. The out of state attorney must determine whether the income is reportable and
whether and when to file a tax return.
Suggested wording for the statement: “Regarding the matters identified in items 3 & 4 of the
Pro Hac Vice Registration Statement, I, [out of state attorney’s name], verify that I will report
any income earned to the North Carolina Department of Revenue if required to do so by law.”
(Please list the case caption above the signed statement.)
 Payment Information: Confirm that the out of state attorney has paid the $25 fee owed to the
North Carolina State Bar pursuant to G.S. 84-4.1(7).
o When filing a pro hac vice motion with a district or superior court of the North
Carolina General Courts of Justice, a fee of $225 should be collected by the clerk of
court in the county. The clerk will remit $25 of this fee to the Administrative Office of
the Courts for ultimate transmission to the State Bar in satisfaction of the payment
required by G.S. 84-4.1(7). Payment to the clerk may be documented with a receipt or
by providing the check number and date of the check.
o When a pro hac vice motion is filed with the NC Court of Appeals, a fee of $225
should be collected by the clerk. The clerk will remit $25 of this fee to the
Administrative Office of the Courts for ultimate transmission to the State Bar in
satisfaction of the payment required by G.S. 84-4.1(7). Payment to the clerk may be
documented with a receipt or by providing the check number and date of the check.
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o When a pro hac vice motion is filed with the NC Supreme Court: Effective October 1,
2009, pursuant to Rule 33 of the NC Rules of Appellate Procedure, out of state counsel
must file a motion for admission pro hac vice to the Supreme Court but does not have
to pay the fee again.
o If the clerk fails to collect the $25 fee for the State Bar, a check or money order for
$25, payable to the North Carolina State Bar, must be submitted to the State Bar with
this registration form.
o The NC Administrative Office of the Courts has determined that there is no separate
$20 filing fee for filing a motion. However, if more than one lawyer applies for pro hac
vice admission in the same motion, $225 is owed for each lawyer seeking admission.
o If the matter is filed in an administrative tribunal (e.g., the Industrial Commission or
the Utilities Commission), mail a $25 check or money order, payable to the North
Carolina State Bar, to the State Bar with this registration form. Mail a $200 check or
money order, payable to the Administrative Office of the Courts to PO Box 2448,
Raleigh, NC 27602, Attention: Kesha Howell. Please enclose a letter to the AOC with
the case number and the name of the tribunal or agency before which the attorney will
appear. No other paperwork should be mailed to the AOC.
o The fee may be paid on behalf of the out of state attorney by the North Carolina
responsible attorney, however, the North Carolina responsible attorney does not owe
this money and, if unwilling to advance the funds and unable to confirm payment or
obtain payment from the out of state attorney, should notify the State Bar.
 Filed Copy for Your Records: If you would like a filed copy of the registration statement
returned to you for your records, send the original and a copy of the registration statement
together with a large self-addressed, stamped envelope.
 Notify the State Bar by letter or email upon the conclusion of the case.
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Post Office Box 25908
Raleigh, North Carolina 27611
Telephone: (919) 828-4620
Web: www.ncbar.gov
PRO HAC VICE ADMISSION REGISTRATION STATEMENT
Filed by the North Carolina Responsible Attorney
Rev. 4/4/18
This registration statement must be filed by the member of the North Carolina State Bar who agrees to be
listed as the responsible North Carolina attorney, pursuant to G.S. 84-4.1(5), in a motion for pro hac vice
admission filed by an attorney who is licensed by another jurisdiction. The North Carolina bar member
must complete and file this registration statement as required by 27 N.C.A.C. 1H, Section .0100, within 30
days of the entry of the court’s order granting admission to the out of state attorney.
PLEASE READ INSTRUCTIONS BEFORE COMPLETING.
NC Proceeding File # ____________________
1. Out of State Attorney Information:
First Name: ________________ Middle: __________ Last: ___________________
Licensure (if more than one, please provide all applicable information)
State: ___________________________________________________
Bar #: ___________________________________________________
Home Address (Required):
____________________________________________
__________________________________________________________
Law Firm Name (if more than one, list on addendum with information requested below):
_________________________________________________________
Business Address:
__________________________________________
_________________________________________________________
Phone #: __________________ Email: _____________________________________
2. North Carolina State Bar Member (Responsible Attorney) Information:
First Name: ________________ Middle: __________ Last: ___________________
N.C. Bar #: _______________________________________________
Address (as listed with State Bar):
_____________________________
_________________________________________________
Phone #: __________________ Email: _____________________________________
For Office Use Only:
Received: ________________
PHV ID: ________________
PHV Order:
Fee Paid:
____ Enclosed
____ Check enclosed
____ Not, enclosed, requested ____________
No.: ____________ Date: ____________
____ Received
____ To Clerk of Court
____ Not Paid, requested ____________
Statement of Tax Reporting:
____ Received
____ Enclosed
____ Not, enclosed, requested ____________
____ Received
Date entered & confirmation sent: ________________
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3. North Carolina Proceeding Information.
(Enclose copy of order)
Venue of Proceeding: ______________________________________
(Court, commission or agency)
County: _________________________________________________
File Name: _______________________________________________
File Number: _____________________________________________
Date of Order Admitting Out of State Attorney: __________________
Type of Case (civil/criminal; tort; contract; workers comp; tax; etc.):
________________________________________________________
Name of Party for Whom Out of State Attorney Appears:
_________________________________________________________
Address of Party for Whom Out of State Attorney Appears:
_________________________________________________________
4. Other Pro Hac Vice Admissions in North Carolina.
Provide the following information (list on addendum if necessary) concerning the last ten cases in
which the out of state attorney was permitted to appear pro hac vice in a North Carolina state
court or North Carolina state agency within the last ten years and any current case(s) in which a
petition for pro hac vice admission for the out of state attorney is still pending:
Venue of Proceeding: ______________________________________
(Court, commission or agency)
County: _________________________________________________
File Name: _______________________________________________
File Number: _____________________________________________
File Date: _______________________________________________
Date of Order Admitting Out of State Attorney: __________________
Name of Judge Who Entered Order: ___________________________
Type of Case (civil/criminal; tort; contract; etc.): __________________
Name of Party for Whom Out of State Attorney Appeared:
_________________________________________________________
Address of Party for Whom Out of State Attorney Appeared:
_________________________________________________________
Name of Responsible North Carolina Attorney: ___________________
_________________________________________________________
N.C. Bar # of Responsible North Carolina Attorney: ______________
Address of Responsible North Carolina Attorney:
_________________
_________________________________________________________
5. Statement of Tax Reporting. Please see page 1 of instructions.
Attach a signed statement (original or photocopy will be acceptable) from out of state attorney
verifying that he/she will report income earned in the matters identified in items 3 and 4 above to
the North Carolina Department of Revenue if required to do so by law. (Please list the case caption
above the signed statement.)
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6. Payment Information. Please see page 1 of instructions.
Indicate method of payment by checking below.
____ Collected by Clerk of Court (if proceeding filed in NC General Court of Justice or NC Court
of Appeals).
Please provide photocopy of receipt or check number and date of check.
Check #__________ Check Date__________
OR
____ Check enclosed, payable to North Carolina State Bar (if the clerk fails to collect the fee or if
the matter is filed in an administrative tribunal).
7. Responsible Attorney Verification.
By signing below, the responsible attorney acknowledges the truth of the foregoing statements and
agrees to notify the State Bar of the final determination of the court or agency proceeding.
____________________________
Signature of NC Attorney
____________________________
Date
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