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Case: 13-1690 Document: 11 Page: 1 05/02/2013 926155 1

ACKNOWLEDGMENT AND NOTICE OF APPEARANCE

Short Title: Docket No.:

Lead Counsel of Record (name/firm) or Pro se Party (name):

Appearance for (party/designation):

DOCKET SHEET ACKNOWLEDGMENT/AMENDMENTS

Caption as indicated is:
( ) Correct
( ) Incorrect. See attached caption page with corrections.

Appellate Designation is:
( ) Correct
( ) Incorrect. The following parties do not wish to participate in this appeal:

Parties:

( ) Incorrect. Please change the following parties’ designations:

Party

Correct Designation

Contact Information for Lead Counsel/Pro Se Party is:
( ) Correct
( ) Incorrect or Incomplete, and should be amended as follows:

Name:
Firm:
Address:
Telephone: Fax:

Email:

RELATED CASES

( ) This case has not been before this Court previously.
( ) This case has been before this Court previously. The short title, docket number, and citation are:

( ) Matters related to this appeal or involving the same issue have been or presently are before this Court. The short titles,
docket numbers, and citations are:


CERTIFICATION

I certify that ( ) I am admitted to practice in this Court and, if required by LR 46.1(a)(2), have renewed my admission on
OR that ( ) I applied for admission on or renewal on
. If the Court has not yet admitted me or approved my renewal, I have completed Addendum A.

OR

Signature of Lead Counsel of Record:
Type or Print Name:

Signature of pro se litigant:
Type or Print Name:
( ) I am a pro se litigant who is not an attorney.
( ) I am an incarcerated pro se litigant.