Free Disclosure of Corporate Affiliations and Financial Interest (rev. 10/07)(pdf)(24kb) - Wisconsin

NOTICE TO COUNSEL: To enable judges and magistrate judges of the court to evaluate possible disqualification or recusal, counsel for a private (non-governmental) business, company, or corporation shall submit at the time of initial pleading this statement of corporate affiliations and financial interest. IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF WISCONSIN

___________________________________ Case No. ______________________ v. ___________________________________

DISCLOSURE OF CORPORATE AFFILIATIONS AND FINANCIAL INTEREST I, the undersigned counsel of record for ______________________________________, make the following disclosure: 1. Is said party a subsidiary or affiliate of a publicly owned corporation? YES NO

If the answer is YES, list below and identify the parent corporation or affiliate and the relationship between it and the named party: 2. Is there a publicly owned corporation, not a party to this case, that has a financial interest in the outcome? YES NO

If the answer is YES, list the identity of such corporation and the nature of the financial interest to the named party:

____________________________________
9/5/08

Date:_______________________________