Gilman Law LLP Plaintiff Certification Form

Plaintiff Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Telephone:
E-mail:
Shares Information
# Shares purchased Date purchased Price per
share
Class of stock
(e.g.Common)
If sold, # of shares sold Date sold
(if sold)
Per share
sold price
Upon submitting this form, a pdf file will be generated that you will need to print out, sign and fax to our offices at (781) 275 - 6428, or print, sign, scan, and email to kgilman@gilmanlawllp.com. Thank you.