UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA CASE NO. ) Plaintiff(s), ) v. ) ) ) ) Defendant(s). ) DISCLOSURE OF CORPORATE AFFILIATIONS AND OTHER ENTITIES WITH A DIRECT FINANCIAL INTEREST IN LITIGATION Only one form need be completed for each nongovernmental party even if the party is represented by more than one attorney. Disclosures must be filed on behalf of nongovernmental corporate parties. Counsel have a continuing duty to update this information. An executed form should be electronicallyfiled laintiff or moving party must serve this on the defendant(s) or respondent(s) when initial service is made. who is (Name of Party) (Plaintiff / moving party or defendant)makes the following disclosure: 1. Is party a publicly held corporation or other publiclyheld entity? Yes No 2. Does party have any parent corporations? Yes No If yes, identify all parent corporations, including grandparent and great-grandparent corporations: 3. Is 10% or more of the stock of a party owned by a publiclyheld corporation orother publiclyheld entity? Yes No If yes, identify all such owners: American LegalNet, Inc. www.FormsWorkFlow.com 4. Is there any other publiclyheld corporation or other publiclyheld entity that has adirect financial interest in the outcome of the litigation? Yes No If yes, identify entity and nature of interest: s/ Signature Date American LegalNet, Inc. www.FormsWorkFlow.com