CIRCUIT RULE 26.1 DISCLOSURE
STATEMENT
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
disclosure statement stating the following information in compliance with
Circuit Rule 26.1 and
Fed. R. App. P. 26.1 .
The Court prefers that the disclosure statement be filed
immediately following docketing; but, the disclosure statement must be filed
within 21 days of docketing or upon the filing of a motion, response, petition,
or answer in this court, whichever occurs first. Attorneys are required to file
an amended statement to reflect any material changes in the required
information. The text of the statement must also be included in front of the
table of contents of the party's main brief. Counsel is required to complete
the entire statement and to use N/A for any information that is not applicable
if this form is used.
(1) The full name of every party that the attorney
represents in the case (if the party is a corporation, you must provide the
corporate disclosure information required by Fed. R. App. P. 26.1 by completing
the item
#3):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(2) The names of all law firms whose partners or
associates have appeared for the party in the case (including proceedings in
the district court or before an administrative agency) or are expected to
appear for the party in this court:
______________________________________________________________________
______________________________________________________________________
(3) If the party or amicus is a
corporation:
i) Identify all its parent corporations, if any;
and
______________________________________________________________________
ii) list any publicly held company that owns 10% or
more of the party's or amicus'
stock:
______________________________________________________________________
______________________________________________________________________
Attorney's
Signature:____________________________________Date:________________________
Attorney's Printed
Name:_____________________________________________________________
Please indicate if you are Counsel of Record for
the above listed parties pursuant to Circuit Rule 3(d). Yes___ No
___.
Address:__________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Phone Number:__________________________________Fax Number:__________________________
E-Mail
Address:_____________________________________________________________________
rev. 11/01 AK