(3)Form of Certificate. The certificate must be signed and dated and substantially in the following form: [style and number of case] Certificate of Interested Persons
(1) The undersigned counsel of record for [party name] to this action certifies to the best of his/her knowledge that the following is a full and complete list of all parties that have ever been named in the case, whether or not the party remains in the case. _________________________________
_________________________________
(2) The undersigned counsel of record for [party name] to this action certifies to the best of his/her knowledge that the following is a full and complete list of all persons who have served as an attorney in this case before the lower courts or administrative agencies. _________________________________
_________________________________
(3) The undersigned counsel of record for [party name] to this action certifies to the best of his/her knowledge that the following is a full and complete list of all persons who were called as a witness at any trial or hearing in this case. _________________________________
_________________________________
Submitted this______day of_________________, 20___.
________________
Counsel for_________________