Disclosure Statement (Criminal Action)

IN THE UNITED STATES DISTRI CT COURT FOR THE NORTHERN DISTRICT O F WEST VIRGINIA UNITED STAT ES OF AMERI CA, ) ) Plaintiff, ) ) v. ) ) _________________________________ ) Criminal Action No. _________________________________________________ ) _________________________________ ) _________________________________ ) _________________________________,) ) Defendant(s). ) ____________________________________) DISCLOSURE STATEMENT P URSUANT TO Fed. R. Cr. P. 12.4(a)(1) (Criminal Action) Pursuant to Rule 12.4(a)(1) of the Federal Rules of Criminal Procedure, the defendant, whois ________________________________________, makes the following disclosure: (name of party) 1. Is the party a non-governmental corporate party? 9 YES 9 NO2. If the answer to Number 1 is yes, list below any parent corporation or state that there is no such corporation: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________3. If the answer to Number 1 is yes, list below any publically-held corporation that owns 10% or more of the partys stock or state that there is no such corporation: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The undersigned party understands that under Rule 12.4(a)(1) of the Federal Rules of<<<<<<<<<********>>>>>>>>>>>>> 2Criminal Procedure, it will promptly file a supplemental statement upon any change in the informationthat this statement requires. ________________________________ Signature of Counsel for PartyDate: ___________________