Free Disclosure Statement - Criminal Form 3 - New Hampshire


File Size: 259.3 kB
Pages: 3
Date: May 26, 2006
File Format: PDF
State: New Hampshire
Category: Court Forms - Federal
Author: danl
Word Count: 300 Words, 2,112 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.nhd.uscourts.gov/pdf/crim3-DisclosureForm.pdf

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UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE

United States of America v. _________________________ ________________________ Defendant(s) _____________________ Criminal Case No.

ORGANIZATIONAL VICTIM STATEMENT LCrR 12.4 (b) [This form is to be completed and filed by the government only when the victim of alleged criminal activity is an organization.] The alleged victim in connection with the above-captioned case is the following organization:

"

The government identifies the following parent corporation and any publicly held corporation that owns 10% or more of the victim's stock:

"

The government identifies the following publicly held corporation with which a merger agreement with the victim exists:

"

Where a partnership is a victim, the government identifies the following publicly held corporation that holds an interest in the partnership, the corporate partner's parent corporation, and any publicly held corporation that owns 10% or more of the corporate partner's stock:

"

The victim has none of the above.

Respectfully submitted,
[Name of Corporation/Partnership] [Name of Corporation/Partnership]

Date:

/s/ [Name of Password Registrant] /s/ [Name of Password Registrant] [Name of Password Registrant] [Name of Password Registrant] [Bar No.] [Bar No.] [Law Firm Name] [Law Firm Name] [Address] [Address] [City, State, Zip Code] [City, State, Zip Code] [Phone: (999) 999-9999] [Phone: (xxx) xxx-xxxx] [E-mail: xxx@xxx.xxx] [E-mail: xxx@xxx.xxx]

CERTIFICATE OF SERVICE I hereby certify that this Disclosure Statement was served on the following persons on this date and in the manner specified herein: Electronically Served Through ECF: [Names of Filing Users]

Conventionally Served: [Name and Address of Non-Filing Users].

Date:

/s/ [Name of Password Registrant] /s/ [Name of Password Registrant] [Name of Password Registrant] [Name of Password Registrant] [Bar No.] [Bar No.] [Law Firm Name] [Law Firm Name] [Address] [Address] [City, State, Zip Code] [City, State, Zip Code] [Phone: (999) 999-9999] [Phone: (xxx) xxx-xxxx] [E-mail: xxx@xxx.xxx] [E-mail: xxx@xxx.xxx]