UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ----------------------------------------------------------X -v---------------------------------------------------------X CERTIFICATION OF SERVICES RENDERED I, , a member of the Bar of the United States District Court for the Eastern District of New York, having been appointed by the Court as Arbitrator in the subject legal action above, hereby certify that on:_____________________________ The arbitration hearing was held The case settled before the hearing The case settled during the hearing Other(describe briefly) I also reviewed the complaint and answer and read the various status cited by the parties in support of the respective claims. Choose if payment should be made to Arbitrator or Firm: Arbitrator: Taxpayer Id: ____________________________ Firm: Taxpayer Id: _________________________________ Type of Business: Address: Woman Owned Minority Owned Other ____________________ Signature:___________________________________ American LegalNet, Inc. www.FormsWorkFlow.com