Disclosure Statement Form

APPENDIX G UNITED STATES DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA : : : : : V. Civil Action No: DISCLOSURE STATEMENT FORM Please check one box: The nongovernmental corporate party, , in the above listed civil action does not have any parent corporation and publicly held corporation that owns 10% or more of its stock. The nongovernmental corporate party, , in the above listed civil action has the following parent corporation(s) and publicly held corporation(s) that owns 10% or more of its stock: Date Counsel for: Signature Federal Rule of Civil Procedure 7.1 Disclosure Statement (a) WHO MUST FILE; CONTENTS. A nongovernmental corporate party must file two copies of a disclosure statement that: (1) identifies any parent corporation and any publicly held corporation owning10% or more of its stock; or (2) states that there is no such corporation. (b) TIME TO FILE; SUPPLEMENTAL FILING. A party must: (1) file the disclosure statement with its first appearance, pleading, petition, motion, response, or other request addressed to the court; and (2) promptly file a supplemental statement if any required information changes. American LegalNet, Inc. www.FormsWorkflow.com UNITED STATE DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA USA v. : : : : : Criminal Action No. DISCLOSURE STATEMENT FORM Please check one box: The nongovernmental corporate party, , in the above listed criminal action does not have any parent corporation and publicly held corporation that owns 10% or more of its stock. The nongovernmental corporate party, , in the above listed criminal action has the following parent corporation(s) and publicly held corporation(s) that owns 10% or more of its stock: Date Counsel for: Signature Federal Rule of Criminal Procedure 12.4 Disclosure Statement (a) WHO MUST FILE. (1) NONGOVERNMENTAL CORPORATE PARTY. Any nongovernmental corporate party to a proceeding in a district court must file a statement that identifies any parent corporation and any publicly held corporation that owns 10% or more of its stock or states that there is no such corporation. (2) ORGANIZATIONAL VICTIM. If an organization is a victim of the alleged criminal activity, the government must file a statement identifying the victim. If the organizational victim is a corporation, the statement must also disclose the information required by Rule 12.4(a)(1) to the extent that it can be obtained through due diligence. (b) TIME FOR FILING; SUPPLEMENTAL FILING. A party must: (1) file the Rule 12.4(a) statement upon the defendant's initial appearance; and (2) promptly file a supplemental statement upon any change in the information that the statement requires. American LegalNet, Inc. www.FormsWorkflow.com