UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE United States of America v. _________________________ Defendant(s) DISCLOSURE STATEMENT LCrR 12.4 (a) [This form is to be completed and filed only by parties that are nongovernmental corporations partnerships or limited liability companies. Check the appropriate box(es).] " The filing party, a nongovernmental corporation, identifies the following parent corporation and any publicly held corporation that owns 10% or more of its stock: Criminal Case No. and Judge's Initials " The filing party, a partnership, identifies the following parent corporation and any publicly held corporation that owns 10% or more of the corporate partner's stock: " The filing party, a limited liability company (LLC), identifies the following parent corporation and any publicly held corporation that owns a 10% or more membership or stock interest in the LLC: American LegalNet, Inc. www.FormsWorkFlow.com " The filing party identifies the following publicly held corporations with which a merger agreement exists: " The filing party has none of the above. Respectfully Submitted, Date: PRINT FORM [Name of Corporation/Partnership/LLC) s/ [Name of Password Registrant] [Name of Password Registrant [Bar No.] [Law Firm Name] [Address] [City, State, Zip Code] [Phone: (999) 999-9999 [Email: xxx@xxx.xxx] CERTIFICATE OF SERVICE I hereby certify that this Disclosure Statement was served on the following persons on this date and in the manner specified herein: Electronically Served Through ECF: [Names of Filing Users] Conventionally Served: [Name and Address of Non-Filing Users] American LegalNet, Inc. www.FormsWorkFlow.com