UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF MICHIGAN Plaintiff, Case Number: vs. Honorable Defendant. / STATEMENT OF DISCLOSURE OF CORPORATE AFFILIATIONS AND FINANCIAL INTEREST Pursuant to LR 83.4, makes the following disclosure: [NOTE: A negative report, if appropriate, is required.] 1. Is said corporate party a subsidiary or affiliate of a publicly owned corporation? Yes No If the answer is Yes, list below the identity of the parent corporation or affiliate and the relationship between it and the named party: 2. Is there a publicly owned corporation or its affiliate, not a party to the case, that has a substantial financial interest in the outcome of the litigation? Yes No If the answer is Yes, list the identity of such corporate or affiliate and the nature of the financial interest: Signature of Counsel Date (Rev. 5-99)