IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND * Plaintiff, * v. * Defendant. * DISCLOSURE OF CORPORATE INTEREST Case No. Check all that apply: I certify, as party/counsel in this case that (name of party) is not an affiliate or parent of any corporation, and no corporation, unincorporated association, partnership or other business entity, not a party to the case, has a financial interest in the outcome of this litigation as defined in Local Rule 103.3 (D. Md.). The following corporate affiliations exist with (name of party) : . (names of affiliates) The following corporations, unincorporated associations, partnerships or other business entities which are not parties may have a financial interest in the outcome of this litigation: . (names of entities with possible financial interests) American LegalNet, Inc. www.FormsWorkFlow.com DisclosureCorpInterest (03/2015) Disclosure of Corporate Interest In a case based on diversity jurisdiction, the following is a list of all members of ________________________________ and their states of citizenship: (name of LLC party) ___________________________________ (name of member) ____________________________________ (state of citizenship) ___________________________________ (name of member) ____________________________________ (state of citizenship) ___________________________________ (name of member) ____________________________________ (state of citizenship) ___________________________________ (name of member) ____________________________________ (state of citizenship) Note: If there are additional LLC members, please provide their names and states of citizenship on a separate sheet of paper. Date Signature Printed name and bar number Address Email address Telephone number Fax number 2 American LegalNet, Inc. www.FormsWorkFlow.com