Free PDF Format - West Virginia

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA

UNITED STATES OF AMERICA,

) ) Plaintiff, ) ) v. ) ) _________________________________ ) _________________________________ ) _________________________________ ) _________________________________ ) _________________________________, ) ) Defendant(s). ) ____________________________________)

Criminal Action No. ________________

DISCLOSURE STATEMENT PURSUANT 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, who is ________________________________________, makes the following disclosure:
(name of party)

1.

Is the party a non-governmental corporate party?

9 YES
2.

9 NO

If the answer to Number 1 is "yes," list below any parent corporation or state that there is no such corporation: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If the answer to Number 1 is "yes," list below any publically-held corporation that owns 10% or more of the party's 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 Page 1 of 2

3.

Criminal Procedure, it will promptly file a supplemental statement upon any change in the information that this statement requires.

________________________________ Signature of Counsel for Party

Date: ___________________

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