United States Courts



United States District Court

for the

DISTRICT OF

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|Plaintiff(s) |) | |

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| |) |Civil Action No. |

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|Defendant(s) |) | |

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STATEMENT NOTING A PARTY'S DEATH

In accordance with Rule 25(a), , who is [a party to this action] [a representative of or successor to the deceased party], notes the death during the pendency of this action of , .

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