UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE United States of America v. _________________________ ________________________ Defendant(s) _____________________ Criminal Case No. ORGANIZATIONAL VICTIM STATEMENT LCrR 12.4 (b) [This form is to be completed and filed by the government only when the victim of alleged criminal activity is an organization.] The alleged victim in connection with the above-captioned case is the following organization: ” The government identifies the following parent corporation and any publicly held corporation that owns 10% or more of the victim's stock: ” The government identifies the following publicly held corporation with which a merger agreement with the victim exists: American LegalNet, Inc. www.FormsWorkflow.com ” Where a partnership is a victim, the government identifies the following publicly held corporation that holds an interest in the partnership, the corporate partner's parent corporation, and any publicly held corporation that owns 10% or more of the corporate partner's stock: ” The victim has none of the above. Respectfully submitted, [Name of Corporation/Partnership] Date: /s/ [Name of Password Registrant] [Name of Password Registrant] [Bar No.] [Law Firm Name] [Address] [City, State, Zip Code] [Phone: (xxx) xxx-xxxx] [E-mail: 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 Date: /s/ [Name of Password Registrant] [Name of Password Registrant] [Bar No.] [Law Firm Name] [Address] [City, State, Zip Code] [Phone: (xxx) xxx-xxxx] [E-mail: xxx@xxx.xxx] American LegalNet, Inc. www.FormsWorkflow.com