CERTIFICATE OF INTEREST
Appellate Court No: _________________
Short Caption:_________________________________________________________
To enable the judges to determine whether recusal is necessary or
appropriate, an attorney for a non-governmental party or amicus curiae, or
a private attorney representing a government party, must furnish a
certificate of interest stating the following information in compliance
with Circuit Rule 26.1. NOTE:
Counsel is required to complete the entire certificate and to use N/A
for any information that is not applicable.
(1) The full name of every party or amicus the attorney represents in
the case:__________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(2) If such party or amicus is a corporation:
i) Its parent corporation, if any; and
______________________________________________________________________
ii) A list of stockholders which are publicly held companies owning 10%
or more of the stock in the party or amicus:
______________________________________________________________________
______________________________________________________________________
(3) The names of all law firms whose partners or associates have
appeared for the party in the case or are expected to appear for the party
in this court:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
This certificate shall be filed with the appearance form or upon the
filing of a motion in this court, whichever occurs first. The attorney
furnishing the certificate must file an amended certificate to reflect any
material changes in the required information. The text of the certificate
(i.e. caption omitted) shall also be included in from of the table of
contents of the party's main brief.
Attorney's Signature:______________________________________________________
Date: _________________________________________________________________
Attorney's Printed Name:___________________________________________________
Address:_______________________________________________________________
______________________________________________________________________
______________________________________________________________________
Phone Number:__________________________________________________________
Amended 10/6/97