APPENDIX LCvR 7.1.A IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF PENNSYLVANIA vs. ) ) ) ) ) ) ) Civil Action No. _______________ or Criminal Action No. ____________ DISCLOSURE STATEMENT Pursuant to LCvR 7.1 of the Western District of Pennsylvania and to enable Judges and Magistrate Judges to evaluate possible disqualification or recusal, the undersigned counsel for ,in the above captioned action, certifies that the following are parents, subsidiaries and/or affiliates of said party that have issued shares or debt securities to the public: or Pursuant to LCvR 7.1 of the Western District of Pennsylvania and to enable Judges and Magistrate Judges to evaluate possible disqualification or recusal, the undersigned counsel for , in the above captioned action, certifies that there are no parents, subsidiaries and/or affiliates of said party that have issued shares or debt securities to the public. Date ______________________________________ Signature of Attorney or Litigant November 1, 2016 American LegalNet, Inc. www.FormsWorkFlow.com