Professional Documents
Culture Documents
R~. S/2OSO
"~. Person Reporting (last name, first~ middle initial)
a o s0
4. Title (,~cle IH judges ~tcate active or senior stares; magis=ate judges indicate ~11- cr p~-6me)
6. Repo~ing P~od to
Nomin~on,
Date
5h, ~ ~endedRepo~ 7. Chambers or Offic~ Addr~s ~~~ ~d I ~~~ fl ~~~ ~" 8. On the bzsis of th~ ino~z~n contained in ~is R~po~ and any modifications p~aining thereto, it is, in my option, i~ ~omplianc~ with app]i~ble laws and re~hfi .... Reviewing Officer Di~e
I34POR TA~VT NO TES: The instructions accompanying this form mttst be followed. Complete all parts, checking the NOz~t~" box for each part where you have no reportable informatlot~ Sign on last page.
III. NON-~STMENT ~CO~. meporting individual and spous,; see pp. I7-24 of ~li.g
~
i,
2, 3, 4.
B. Spouses Non-Investnl ent In come - xf yo. were married during any por~ion of the reporting year, complete this sectio~
(~otlor amount not requir~d ~ce~t for honoraria.)
IV. REIMBURSEMENTS (Includes tho.g to spouse and dependent children," ace p.o. 25-27 offiling inatruct/ons.)
~
1. 2. 3. 4. 5.
Page 3 of~ ~
~ ~ ~/
~ ~ 0
,
Date of Report
q_ ~ _/~
V. GIFTS. a,~t~a,, ,~.o,~ ,o ,v ....... u aependent d, ildren; see pp. 2S-31 o:fiting instructio,u.)
~
!.
SO~
DESCR~TION
~1~
3,
4,
5.
2. 3. 4. 5.
Dateof~eport
7
IX. CERTIFICATION.
I certify" that all inlormation given above (including information pertaining to my spouse and minor or dependent children, if any) is accurate, ~rue, and complete to the best of my knowledge and belief, and that any information not reported was withheld because it met applicable statutory provisions permitting non-disclosure. I further certify that earned income from outside employment and honoraria and the acceptance of gifts which have been reported are in compliance "with the provisions of 5 U.S.C. app. 501 et. seq, 5 U.S.C. 7353, and Judicial Conference regulations.
Si
NOTE: AN~ INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES OR FAILS TO FILE THIS REPORT lVlAY BE SUBJECT TO ClvqL AND CRIMINAL SANCTIONS (5 U.S.C. app. 104)
FILING INSTRUCTIONS Mail signed original and 3 additional copies to: Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544