Free Corporate Disclosure Form For Litigation - North Carolina

UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA
) ) Plaintiff(s), ) ) vs. ) ) ) Defendant(s). ) __________________________________________)

Case No.

DISCLOSURE OF CORPORATE AFFILIATIONS AND OTHER ENTITIES WITH A DIRECT FINANCIAL INTEREST IN LITIGATION
ONLY ONE FORM NEED BE COMPLETED FOR EACH NONGOVERNMENTAL PARTY EVEN IF THE PARTY IS REPRESENTED BY MORE THAN ONE ATTORNEY. DISCLOSURES MUST BE FILED ON BEHALF OF INDIVIDUAL NONGOVERNMENTAL PARTIES AS WELL AS NONGOVERNMENTAL CORPORATE PARTIES. COUNSEL HAVE A CONTINUING DUTY TO UPDATE THIS INFORMATION. PLEASE FILE AN ORIGINAL AND ONE COPY OF THIS FORM. PLAINTIFF OR MOVING PARTY MUST SERVE THIS ON THE DEFENDANT(S) OR RESPONDENT(S) WHEN INITIAL SERVICE IS MADE. _______________________ who is _________________________________, (Plaintiff/moving party or defendant) (Name of party.) makes the following disclosure: 1. 2. Is party a publicly held corporation or other publicly held entity ? ( ) Yes ( ) No Does party have any parent corporations ? ( ) Yes ( ) No If yes, identify all parent corporations, including grandparent and great-grandparent corporations:______________________________________________ __________________________________________________________________ __________________________________________________________________ Is 10% or more of the stock of a party owned by a publicly held corporation or other publicly

3.

held entity ? ( ) Yes ( ) No If yes, identify all such owners:___________________________________________________________ __________________________________________________________________ __________________________________________________________________

4.

Is there any other publicly held corporation or other publicly held entity that has a direct financial interest in the outcome of the litigation ? ( ) Yes ( ) No If yes, identify entity and nature of interest:_______________________________ __________________________________________________________________ __________________________ ______________________ (Signature) (Date)

(02/01)