UNITED STATES DISTRICT COURT WESTERN DISTRICT OF

W DMI Corporate Disclosure Statement pursuant to Fed. R. Civ. P. 7.1 or Fed. R. Crim. P. 12.4 (4/06)

UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF MICHIGAN

Plaintiff(s), Case No.

Defendant(s).

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DISCLOSURE OF CORPORATE AFFILIATIONS AND FINANCIAL INTEREST

Pursuant to _________________________________

(Party Name)

makes the following disclosure:

1. Is party a publicly held corporation or other publicly held 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 party owned by a publicly held corporation or other

publicly held entity? Yes No

If yes, identify all such owners:

4. Is there any other publicly held corporation or other publicly held entity that has a direct

financial interest in the outcome of the litigation? Yes No

If yes, identify entity and nature of interest:

Date: __________________________ ___________________________________

(Signature)

Federal Rule of Civil Procedure 7.1,

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