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)(2) (Criminal Action) Pursuant to Rule 12.4(a)(2) of the Federal Rules of Criminal Procedure, a copy of which has been provided to the United States of America by the Clerk, the United States of America makes the following disclosure: 1. Is any organization involved in any way in this criminal proceeding a victim of any criminal activity in this proceeding?

9 YES
2.

9 NO

If the answer to Number 1 is "yes," list below the full name of any such victim or victims:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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3.

If the answer to Number 1 is "yes" and any above-listed organizational victim is a corporation, list below any parent corporation of the organizational victim(s) or state that there is no such corporation: ________________________________________________________________________ ________________________________________________________________________ If the answer to Number 1 is "yes" and any above-listed organizational victim(s) is a corporation, list below any publically held corporation that owns 10% or more of the organizational victim(s)' stock or state that there is no such corporation: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

4.

The United States of America understands that under Rule 12.4(a)(2) of the Federal Rules of Criminal Procedure, it will promptly file a supplemental statement upon any change in the information that this statement requires.

UNITED STATES OF AMERICA, plaintiff By: ________________________________

Date: ___________________

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