Free Conflict Disclosure Statement (Fillable PDF) - Alabama

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF ALABAMA ________________________ DIVISION _________________________________, Plaintiff, v. _________________________________, Defendants, ) ) ) ) ) ) ) ) )

CASE NO. __________________

CONFLICT DISCLOSURE STATEMENT COMES NOW ___________________, a in the above-captioned matter, and in accordance with the order of this Court, making the following disclosure concerning parent companies, subsidiaries, partners, limited liability entity members and managers, trustees (but not trust beneficiaries), affiliates, or similar entities reportable under the provisions of the Middle District of Alabama's General Order No. 3047: This party is an individual, or This party is a governmental entity, or There are no entities to be reported, or The following entities and their relationship to the party are hereby reported: Reportable Entity ________________________________ ________________________________ ________________________________ ________________________________ Date Relationship to Party _________________________________ _________________________________ _________________________________ _________________________________ (Signature) (Counsel's Name) Counsel for (print names of all parties) Address, City, State Zip Code Telephone Number

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF ALABAMA ________________________ DIVISION CERTIFICATE OF SERVICE

I,____________________________________, do hereby Certify that a true and correct copy of the foregoing has been furnished by ___________________________(manner of service, i.e., U.S. Mail, electronic mail, etc.) on this _______day of ____________ 20__, to:

Date

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