USDC/ATTY-010 | F R Civ P 7.1 (12/06) Disclosure of Corporate Affiliations and Financial Interest UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF WEST VIRGINIA AT SELECT ONE: DISCLOSURE OF CORPORATE AFFILIATIONS AND FINANCIAL INTEREST V. CASE NUMBER Pursuant to F R Civ P 7.1, any nongovernmental corporate party to an action or proceeding in a district court must: 1) identify any parent corporation and any publicly held corporation that owns ten percent or more of its stock; or 2) must state that there is no such corporation. Name of party: _________________________________________________________________ Check all that apply: I certify, as party/counsel in this case, that the above named party is not an affiliate or parent of any corporation, and no corporation, unincorporated association, partnership or other business entity, not a party to the case, has a financial interest in the outcome of this litigation. The following corporate affiliations exist with the above named party : Parent corporation/affiliate name: _____________________________________________ Relationship with named party: _______________________________________________ The following corporation, unincorporated association, partnership, or other business entities which are not parties may have a financial interest in the outcome of this litigation: Parent corporation/affiliate name: _____________________________________________ Nature of financial interest: __________________________________________________ _____________________________________________ Parent corporation/affiliate name: _____________________________________________ Nature of financial interest: __________________________________________________ Date: ___________________ ____________________________________t American LegalNet, Inc. www.FormsWorkFlow.com