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