2
PO Box 25908
Raleigh, North Carolina 27611
Telephone: (919) 828-4620
Rev. 1/7/16
UPDATE FORM
To Update a Prior Pro Hac Vice Admission Registration Statement
(When Admission Pro Hac Vice is granted
by the North Carolina Court of Appeals)
Filed by the North Carolina Responsible Attorney
This update form 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 to the NC Court of Appeals filed by an attorney who is licensed by another jurisdiction.
PLEASE READ INSTRUCTIONS BEFORE COMPLETING.
1. Out of State Attorney:
First Name: _________________ Middle: __________ Last: _________________
2. North Carolina State Bar Member (Responsible Attorney) Information.
First Name: _________________ Middle: __________ Last: _________________
NC Bar #: ______________________________________________
Address (as listed with State Bar): _____________________________
_________________________________________________
Phone #: ____________________Email:___________________________________
3. North Carolina Court of Appeals Case Information.
(Enclose copy of motion and order)
File Name: _______________________________________________
File Number: _____________________________________________
Date of Order Admitting Out of State Attorney: __________________
4. Payment Information. Please provide photocopy of receipt or check number and date of
check. Receipt Enclosed ______ or Check #__________ Check Date__________
5. Responsible Attorney Verification.
By signing below, the responsible attorney acknowledges that truth of the foregoing statements
and agrees to notify the State Bar of the final determination of the court proceeding.
____________________________ ___________________________
Signature of NC Attorney Date
For Office Use Only:
Lower Court: PHV-___________
Received: ___________________ Date Entered: ________________ Date acknowledged: __________
Fee Paid: __________ Motion Received: ________ Order Received: _______