Criminal Disclosure Statement

UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF ALABAMA ) ) ) ) ) ) ) ) ________________________________ vs. ________________________________ Criminal Action No._______________ CRIMINAL DISCLOSURE STATEMENT Pursuant to Criminal Local Rule 12.4 of the Southern District of Alabama and to enable Judges and Magistrate Judges to evaluate possible disqualification or recusal, the undersigned counsel for _____________________________________________________________________ certifies as follows: (1) Non-governmental Parties and Amici Curiae. A. state the full name of every party or amicus the attorney represents in the action; and B. if such party or amicus is a corporation: i. ii. identify any parent corporation and any publicly held corporation owning 10% or more of its stock; or state there is no such corporation; and C. state the names of all law firms whose attorneys will appear, or are expected to appear, for the party in this Court. . ALSD Rev. 5/2014 American LegalNet, Inc. www.FormsWorkFlow.com (2) Organizational Victims. A. state the full name of every victim that has been identified; and B. if such victim is a corporation: i. ii. identify any parent corporation and any publicly held corporation owning 10% or more of its stock; or state there is no such corporation. . _________________________________ Date ______________________________ Signature of Attorney 2 ALSD Rev. 5/2014 American LegalNet, Inc. www.FormsWorkFlow.com