FOR CALENDAR YEAR 2010 (5 U.S.C. app )
|
|
|
- Barbra Daniel
- 8 years ago
- Views:
Transcription
1 O Brien, Terrence L. AO I0 FINANCIAL DISCLOSURE REPORT Rev. 1/2011 FOR CALENDAR YEAR 2010 (5 U.S.C. app ) Report Required by the Ethics in Government Act of Person Reporting (last name, first, middle initial) Court or Organization O Brien, Terrence L. Tenth Circuit 05/14/2011 Title (Article Ill judges indicate active or senior status; 5a. Report Type (check appropriate type) 6. Reporting Period magistrate judges indicate full- or part-time) ] Nomination, Date 01/01/2010 U.S. Circuit Judge - Active [] Initial [] Annual [] Final to 12/31/2010 5b. [] Amended Report 7. Chambers or Office Address 8. On the basis of the information contained In this Report and any modifications pertaining thereto, it is, in my opinion, in ompliance U.S. Court of Appeals, Tenth Circuit with applicable laws and regulations CareyAve., Suite 200 Cheyenne, WY Reviewing Officer Date IMPORTANT NO TES: The instructions accompanying this form must be followetl Complete all parts, checking the NONE box for each part where you have no reportable informatiot~ Sign on last page. I. POSITI O N S. (Reporting individual only; see pp of filing instructions.) NONE (No reportable positions.) POSITION NAME OF ORGANIZATION/ENTITY II. AGREEMENTS. (Rcpo.i.g individual only; seepp of filing instructions.) ~] NONE (No reportable agreements.) DATE PARTIES AND TERMS
![Report Type (check appropriate type) 6. Reporting Period magistrate judges indicate full- or part-time) ] Nomination, Date 01/01/2010 U.S.](/docs-images/49/18234245/images/page_1.jpg "Circuit Judge - Active [] Initial [] Annual [] Final to 12/31/2010 5b. [] Amended Report 7. Chambers or Office Address 8.")
2 Page 2 of 8 O Brien, Terrence L. 05/14/2011 III. NON-INVESTMENT INCOME. (Rcpo.l.g individual andspouse; seepp of filing instructions.) A. Filer s Non-Investment Income ~ NONE (No reportable non-investment income.) DATE SOURCE AND TYPE INCOME (yours, not spouse s) I State of Wyoming - Judicial Retirement $50, B. Spouse s Non-Investment Income - If you were married during anyportion of the reporting year, complete this section. (Dollar amount not required except for honoraria.) NONE (No reportable non-investment income.) DATE SOURCE AND TYPE 1. IV. REIMBURSEMENTS - transportation, Iodglng, food, entertalnmen~ (Includes those to spouse and dependent children; see pp of filing instructions.) NONE (No reportable reimbursements.) SOURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED 1. 5.
3 Page 3 of 8 O Brlen, Terrence L. 05/14/2011 V. GIFTS. anauaes those to spouse ond dependent children; see pp of f!ling instructions.) D NONE (No reportable gifts.) SOURCE DESCRIPTION VALUE Wooden Chest April Brimmer Kunz $ Air Fare Cheyenne Vancover Cheyenne Marian Rochelle $ Alaska Tours April Brimmer Kunz $ Alaska Cruise Marian Rochelle $5, Metz- Lewis & Clark Book Marian Rochelle $2, Thomas Bronze (I/2 interest) Marian Rochelle $3, Misc Gifts April Brimmer Kunz $ Christmas & Birthday Gifis~ $ VI. LIABILITIES. (Includes those of spouse and dependent children; seepp of filing instructions.) NONE (No reportable liabilities.) CREDITOR DESCRIPTION VALUE CODE 1. 5.
4 Page 4 of 8 O Brien, Terrence L. 05/14/2011 VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; seepp of fillng instructions.) D NONE (No reportable income, assets, or transactions.) A. B. C. Description of Assets Income during Gross value at end (including trust assets) reporting period of reporting period (l) (2) (1) (2) (I) Place "(X)" after each asset Amount Type (e.g., Value Value Type (e.g., exempt from prior disclosure Code l div., rent, Code 2 Method buy, sell, (A-H) or int.) (J-P) Code 3 redemption) Transactions during reporting period (2) (3) (4) (5) Date Value Gain Identity of mm/dd/yy Code 2 Code 1 buyer/seller (J-P) (A-H) (if private transaction) 1. IRA# 1 Wy Defer Compt Artisan Mid Cap A Dividend Sold ARTMX IRA # 1 Wy Retire Acct Dreyfus Money A Dividend Sold Market Reserves IRA#1 WY Defer Comp Dodge & Cox Intl A Dividend Sold Stock Fund IRA#1 WYDefer Comp Perkins Mid Cap A Dividend Sold Value Fund 5. 1RA#1 WY Defer Comp Black Rock Russell A Dividend Sold 1000 Growth Index T 6. IRA #2 BA (TD Ameritrade - IRA) A Dividend Sold 7. IRA #2 CLX (TDA-IRA) A Dividend Sold 8. IRA #2 CVX (TDA-IRA) A Dividend Sold 9. IRA#2 DRYS (TDA_IRA) A Dividend Sold 10. IRA #2GR (TD-IRAA) A Dividend Sold 11. IRA#2 Cash Equivalent Account (TDA- A Interest L T IRA) 1 BKH (TDAmeritrade) A Dividend Sold 1 BA (TDA) A Dividend Sold 1 CAT (TDA) A Dividend Sold 15. GLW (TDA) A Dividend Sold 16. DD (TDA) A Dividend Sold 17. FCX (~fda) A Dividend Sold 12/27/10 K C Proceeds to Line 33 12/27/10 J A Proceeds to line 33 12/27/I 0 K A Proceeds to line 33 12/27/10 K D Proceeds to line33 12/27/10 K B Proceeds to Line 33 12/09/10 J A 12/09/10 J C 12/09/10 J A 12/09/10 J B Converted to Roth IRA 12/09/10 J C 12/09/10 L E 1. Income Gain Codes: A =$1,000 or less B =$1,001 - $2,500 C =$2,501 - $5,000 (See Columns B 1 and D4) F =$ 50,001 - $ G =$100,001 - $1,000,000 H 1 =$ 1,000,001 - $ 5,000,000 Value Codes J =$15,000 or less K =$15,001 - $50,000 L =$50,001 - $100,000 (See Columns C I and D3) N =$250,001 - $500,000 O =$500,001 - $1,000,000 PI =$1,000,001 - $5,000,000 P3 =$25, $50,000,000 P4 =More than $50,000,000 Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment (See Column C2) LI =Book Value V =Other W =Eslimatcd D =$5,001 - $15,000 E =$15,001- $50,000 H2 =M ore than $5,000,000 M =$ 100,001 - $250,000 P2 =$5,000,001 - $25,000,000 T =Cash Market
5 FINANCIAL DISCLOSURE REPORT Page 5 of 8 O Brien, Terrence L. 05/14/201 I VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; seepp of filing instructions.) D NO]qE(No reportable income, assets, or transactions.) A. B. C. Description of Assets Income during Gross value at end Transactions during reporting period (including trust assets) reporting period of reporting period O) (2) (0 (2) (1) (2) (3) (4) Place "(X)" after each assel Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of exempt from prior disclosure Code 1 div.. rent, Code 2 Method buy, sell, mm/dd/yy Code 2 Code 1 buyer/seller (A-H) or int.) (J-P) Code 3 redemption) (J-P) (A-H) (if private (Q-W) transaction) 18. IBM ( IDA) A Dividend Sold 12/09/10! K E 19. JNJ (TDA) A Dividend Sold 12/09/10 K B 20. KMB (TDA) A Dividend Sold 12/09/10 J A 21. PEP ( IDA) A Dividend Sold 12/09/10 J A was PAS 2 RTP (TDA) A Dividend Sold 12/09/10 K E 2 JAVA (TDA) A Dividend Sold 01/28/10 J A 2 TRA ( IDA) A Dividend Sold 04/26/10 K D 25. TRN (TDA) A Dividend Sold 12/09/10 K C 26. UNP ( IDA) A Dividend Sold 27. VLO (TDA) A Dividend Sold 12/09/10 K B 28. CF (TDA) A Dividend Buy 04/16/10 J 29. CF (TDA) A Dividend Sold 12/09/10 J A 30. PTHAX (TDA) A Interest J T 31. ATCHX (TDA) A Interest J T was VKMHX 3 Cash Equivalent Account (TDA) A Interest N T Was CMFUZ 3 Roth IRA Fidelity Investments A lnt./div. M T Buy 01/03/11 M 3 BRKB(Fidelity Investments) A Dividend Sold 12/09/10 K A I. Income Gain Codes: A =$1,000 or less B =$1,001 - $2,500 C =$2,501 - $5,000 D =$5,001 - $15,000 E =$15,001 - $50,000 (See Columns B I and D4) F =$50,001 o $100,000 G =$ 100,001 - $ 1,000,000 H I =$1,000,001 - $5,000,000 H2 =More than $5,000,000 Value Codes J =$15,000 or less K =$15,001 - $50,000 L =$50,001 - $ 100,000 M =$100,001 - $250,000 (See Columns C I and D3) N =$250,001 - $500,000 O =$500,001 - $ 1,000,000 P 1 =$ 1,000,001 - $5,000,000 P2 =$5,000,001 - $25,000,000 P3 =$25,000,001 - $50,000,000 P4 -More than $50,000,000 Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market (See Column C2) U =Book Value V =Other W =Estimated
6 Page 6 of 8 O Brien, Terrence L. 05/14/2011 VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; see pp of fillng instructions.) NONE (No reportable income, assets, or transactions.) A. B C. D. Description of Assets Income during Gross value at end Transactions during reporting period (including trust assets) reporting period of reporting period (l) (2) (t) (2) (l) (21 (3) (4) (5) Place "(X)" after each asset Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of exempt from prior disclosure Code 1 div., rent, Code 2 Method buy, sell, mm/dd/yy Code 2 Code I buyer/seller (A-H) or int.) (J-P) Code 3 redemption) (J-P) (A-H) (if private (Q-W) transaction) 35. IBDRY (Fid) A Dividend Sold 12/09/10 J A 36. BA(Fid) A Dividend Sold 12/09/10 J A 37. FH1GX (Fid) A Dividend L T 38. FTEXX Money Market Account (Fid) A Interest M T 39. Transamerica Annuity #1 A Interest K T was Pacific Fidelity Life 40. Transamerica Annuity #2 A Interest K T was PFL Transamerica Annuity #3 41. A Interest K T was PFL 4 Promissory Note from~... D Interest N T Buy 05119/10 4 First Interstate Bank Gillette WY Cash Equiv Acct A Interest M T 4 USAA Fed Savings Bank, San Antonio, TX Cash Equiv Acct A Interest M T 45. First NB, Buffalo, WY Cash Equiv Acct A Interest J T 46. American NB, Cheyenne, WY Cash Equiv A Interest L T Acct Closed Acct 47. U S Coins None J T 48. U.S. Bonds A Interest J T I. Income Gain Codes: A =$1,000 or less B =$1,001 - $2,500 C =$2,501 - $5,000 D =$5,001 - $15,000 E =$15,001- $50,000 (See Columns B 1 and D4) F =$ 50,001 - $ 100,000 G =$100,001 - $ 1,000,000 H 1 ~$1,000,001 - $5,000,000 H2 =More than $ 5,000,000 Value Codes J =$15,000 or less K =$15,001 - $50,000 L =$50,001 - $100,000 M =$100,001 - $250,000 (See Columns CI and D3) N =$ $500,000 O =$500,001 - $1,000,000 P1 =$1,000,001 - $5,000,000 P2 =$5,000,001 - $25,000,000 P3 -$25,000,001 - $50.000,000 P4 =More than $50,000,000 Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market (Sce Column C2) U =Book Value V =Other W =Estimated
7 FINANCIAL DISCLOSURE REPORT Page 7 of 8 O Brien, Terrence L. 05/14/2011 VIII. ADDITIONAL INFORMATION OR EXPLANATIONS. (lndicate part of report.) Section VII - I converted my State of Wyoming IRA (lines!-5) to a Roth IRA with Fidelity Investments (line 33). The SOW issued a check on 12/27/2010 but it did not reach Fidelity for credit to the Roth IRA account until 01/03/2011
8 Page 8 of 8 O Brien, Terrence L. 05/14/2011 IX. CERTIFICATION. 1 certify that all information given above (including information pertaining to my spouse and minor or dependent children, if any) is accurate, true, 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. Signature: S/Terrence L. O Brien NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES OR FALLS TO FILE THIS REPORT MAY BE SUBJECT TO CIVIL AND CRIMINAL SANCTIONS (5 U.S.C. app. 104) Committee on Financial Disclosure Administrative Office of the United States Courts Suite One Columbus Circle, N.E. Washington, D.C
D NONE (No reportable positions.)
Brimmer, Philip A. A01.0 Rev. 112/Jfl Report Required by the Ethics FINANCIAL DISCLOSURE REPORT in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) I. Person Reporting (last name,
D NONE (No reportable positions.)
Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2011 (5 U.S.C. app. 101-111) I. Person Reporting (last name, first, middle initial) Court or Organization Smith, William E. District
state Of Pennsylvania Munley, PA Personal/Business Tax Deductions
Munley, James M. AO IO Rev. 112011 FINANCIAL DISCLOSURE REPORT in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-11 I) Report Required by the Ethics 1. Person Reporting (last name, first,
FOR CALENDAR YEAR 2010 (5 U.S.C. app..~.~" I01-111)
Kane, Yvette Report Required by the Ethics AO 10 FINANCIAL DISCLOSURE REPORT in Govermnent Act of 1978 Rev. 1/2011 FOR CALENDAR YEAR 2010 (5 U.S.C. app..~.~" I01-111) I. Person Reporting (last name, first,
D NONE (No reportable positions.)
AOJO Rev. 112013 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2012 (5 U.SC. app. 101-111) I. Person Reporting (last name, first, middle initial)
FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2007. U.S. District Court. D Initial. Amended Report. Sb. Reviewing Officer
AOJO Rev. 112008 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2007 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111) 1. Person Reporting (last name, first, middle initial)
[{ NONE (No reportable positions.)
.. AOJO Rev. 112011 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app ff JOI-I I I) Person Reporting (last name, first, middle initial)
[{ NONE (No reportable positions.)
1 AOJO Rev. 112013 Report Required by the Ethics in Government Act
D NONE (No reportable positions.)
AO JO Rev. 112013 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2012 (5 U.S.C. app. 101-111) I. Person Reporting (last name, first, middle initial)
D NONE (No reportable positions.)
AOlO Rev. 112012 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2011 (5 U.S.C. app. 101-111) I. Person Reporting (last name, first, middle initial)
D NONE (No reportable positions.)
AOIO Rev. l/20ll FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2010 Report Required by Jhe E1hics in Governmenl Ac/ of 1978 (5 U.S.C. app. 101-1l1) I. Person Reporting (last name, first, middle initial)
[{] NONE (No reportable positions.)
![[{] NONE (No reportable positions.)](/thumbs/39/19404004.jpg "[{] NONE (No reportable positions.)")
AO JO Rev. 112013 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2012 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app.. H 101-111) I. Person Reporting (last name, first, middle initial)
D NONE (No reportable positions.)
FINANCIAL DISCLOSUR REPORT Report Required by the Ethics AOJO in Government Act of 1978 Rev. 112007 FOR CALENDAR YEAR 2006 (5 U.S.C. app. 101-1I1) 1. Person Reporting (last name, first, middle initial)
[K NONE (No reportable positions.)
A010 Rev.112007 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2006 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111) 1. Person Reporting (last name, first, middle initial)
September 20, 2007. Re: Dean D. Pregerson, 2006 Financial Disclosure Report. Dear Ortrie D. Smith,
September 20, 2007 Committee on Financial Disclosure Administrative Office of the United States Courts One Columbus Circle N.E., Suite 2-301 Washington D.C. 20544 o> }> ljr., Re: Dean D. Pregerson, 2006
D NONE (No reportable non-investment income.) [Z NONE (No reportable non-investment income.) D NONE (No reportable reimbursements.
Williams_Ann_C Name of Person Reporting Date of Report Page 2of6 Williams, Ann C. 0511312009 Ill. NON-INVESTMENT IN COME. (Reporting individual and spouse; see pp. 17-24 offiling instructions.) A. Filer's
[R NONE (No reportable positions.)
Johnson, Thomas E. AO JO Rev. 11201 / FINANCIAL DISCLOSURE REPORT Report Required by rhe Erhics in Gm emmenr Acr of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. JOI-I/ I) Person Reporting (last name, first,
Report Required by the Ethics AOIO in Government Act of 1978 Rev. 112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. JOI-I I I) FINANCIAL DISCLOSURE REPORT
Report Required by the Ethics AOIO in Government Act of 1978 Rev. 112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. JOI-I I I) 1. Person Reportng (last name, first, middle initial) Court or Organization U.S.
Person Reporting - A Practical Legal Guide
AOIO Rev. 112013 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2012 (5 U.S.C. app..h 101-111) I. Person Reporting (last name, first, middle initial)
D NONE (No reportable positions.)
Report Required by the Ethics AOlO in Government Act of 1978 Rev.112007 FOR CALENDAR YEAR 2006 (5 u.s.c. app. 101-111) J. Penon Reporting Qast name, first, middle initial) Bea, Carlos T 2. Court or Organization
UNITED STATES DISTRICT COURT
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA CHAMBERS OF TIMOTHY J. SAVAGE DISTRICT JUDGE 9614 UNITED STATES COURTHOUSE INDEPENDENCE MALL PHILADELPHIA, PENNSYLVANI A 19106 267-299-7480
D NONE (No reportable positions.)
AO 10 Rev. 112012 FINANCIAL DISCLOSURE REPORT Report Required by the E1/1ics in Government Act of 1978 FOR CALENDAR YEAR 2011 (5 U.S.C. app. /0/-1 //) 1. Person Reporting (last name, first, middle initial)
D NONE (No reportable positions.)
AO JO Rev. 112012 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2011 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. JOI-Ill) I. Person Reporting (last name, first, middle initial)
FINANCIAL DISCLOSURE REPORT. 2. Court or Organization. U.S.D.C. - S.D. Tx. Sa. Report Type (check appropriate type) D Nomination,
Atlas, Nancy F. ;Aoio Rev. 112011 Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) I. Person Reporting (last name, first, middle initial) Court or
D NONE (No reportable positions.)
Tunheim. John R. AO JO Rev. 112011 FINANCIAL DISCLOSURE REPORT Report Required by 1he E1hics in Governmenl Ac/.of1978 FOR CALENDAR YEAR 2010 (5 U.SC. app. JOI-I I I) I. Person Reporting (last name, first,
[K NONE (No reportable positions.)
Report Required by the Ethics AO IO in Government Act of I978 Rev. J/2007 FOR CALENDAR YEAR 2006 (5 U.S.C. app. IOI-I I I) I. Person Reporting (last name, first, middle initial) Court or Organization TEILBORG,
D NONE (No reportable positions.)
AO JO Rev. 112008 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2008 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. JOI-I I I) I. Person Reporting (last name, first, middle initial)
[Z NONE (No reportable positions.)
.. AO JO FNANCAL DSCLOSURE REPORT Report Required by the Ethics 111 Government Act of 1978 Rev. 112008 FOR CALENDAR YEAR 2007 (5 USC opp. Ol-llJ) L Person Reporting (last name. first, middle initial) Court
FINANCIA DISCLOSUR REPORT. in Government Act of 1978 FOR CALENDAR YEAR 2004 (5 U.S.C. app. 101-111) District of Kansas. Q Nomination, Date
.... A0-10 Rev. l/2004 FINANCIA DISCLOSUR REPOR Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2004 (5 U.S.C. app. 101-111) Person Reporting (Last name, First name, Middle initial)
II. AGREEMENTS. (Reporting individual only; see pp. 14-16 of filing instructions.) C- 9 0 _o rn 0 0 NONE (No reportable agreements.
I. POSITI0NS. (Reporting individual only; see pp. 9-13 of filing instructions.) 0 NONE (No reportable positions.) NAME OF ORGANIZATION/ENTITY I. Director Las Familias del Pueblo (a not-for-profit corporation),..._,...
FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2006. U.S. District Court, Mass. D Initial Annual. Amended Report. Sb.
O IO Rev. 112007 FINNCIL DISCLOSURE REPOR FOR CLENDR YER 2006 Report Required by the Ethics in Government ct of 1978 (5 U.S.C. app. 101-111) l. Person Reporting (last name, first, middle initial) Court
D NONE (No reportable positions.)
Webber, E. Richard AO JO Rev. J/20ll FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Go1 ernment Act of 1978 FOR CALENDAR YEAR 2010 (5 V.S.C. app. 101-1 I I) Penon Reporting (last name, first,
D NONE (No reportable positions.)
Rader, Randall R. FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) 1. Person Reporting {last name, first, middle initial)
D NONE (No reportable positions.)
AOlO FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Governent Act of 1978 Rev.112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. 101-111) 1. Person Reporting Oast name, first, middle Initial) Court
D NONE (No reportable positions.)
AO IO Rev. 112006 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of1978 FOR CALENDAR YEAR 2005 {5 US.C. app. IOI-II I) I. Person Reporting (last name, first, middle initial)
D NONE (No reportable non-investment income.)
Danniels_George_B FNANCAL DSCLOSURE REPORT Page 2of6 Daniels,, George B. 05/6/2009. N 0 N-NVESTMENT N CO ME. (Reporting individual and spouse; see pp. 17-14 of filing instructions.) A. Filer's Non-nvestment
D NONE (No reportable positions.)
O IO Rev. 112011 FINNCIL DISCLOSURE REPORT FOR CLENDR YER 2011 Report Required by the Ethics in Government ct of 1978 (5 U.S.C. app. IOI-Ill) I. Person Reporting (last name, first, middle initial) Court
[Z NONE (No reportable non-investment income.) D NONE (No reportable non-investment income.) [Z NONE (No reportable reimbursements.
Nelson_Thomas_G FNANCAL DSCLOSURE REPORT Page 2of6 Name or Person Reporting Date or Report NELSON, THOMAS G. 03/06/2009 J J J. N 0 N-JNVESTMENT N CO ME. (Reporting indmdual and spouse; see pp. 17-4 of
D NONE (No reportable positions.)
O O FINNCIL DISCLOSURE REPOR in Government ct of I 978 Rev. 112007 FOR CLENDR YER 2006 (5 U.S.C. app. OI-I II) Report Required by the Ethics Person Reporting (last name, first, middle initial) Court or
FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2005. 2. Court or Organization. Wester District of Missouri. Sa. Report Type {check appropriate type)
AOlO Rev. 1126 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics FOR CALENDAR YEAR 25 in Government Act of 1978 (5 U.S.C. app. 11-111) Person Reporting (last name, first, middle initial) Laughrey,
AOIO FINANCIAL DISCLOSURE REPORT. in Government Act of 1978 Rev. 112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. 101-1 Jl) 2. Court or Organization
' Report Required by the Ethics AOO FNANCAL DSCLOSURE REPORT in Government Act of 1978 Rev. 112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. 101-1 Jl). Person Reporting (last name, first, middle initial) Copenhaver,
D NONE (No reportable positions.)
Kol lar-kotel Iv, Colleen AO JO Rev. 112011 Report Required by the Ethics FINANCIAL DISCLOSURE REPORT in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-11 l) I. Person Reporting (last
[{ NONE (No reportable positions.)
Wi 11 iams, Stephen F. AO JO Rev. 112011 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. IOI-I I I) Person Reporting (last name,
D NONE (No reportable positions.)
Bolton, Susan R. Report Required by the Ethics FINNCIL DISCLOSURE REPOR in Government ct of 1978 FOR CLENDR YER 2010 (5 U.S.C. app. 101-111) 1. Person Reporting (last name, first, middle initial) 2. Court
financial DiScloSure report
Filing ID #10005556 financial DiScloSure report Clerk of the House of Representatives Legislative Resource Center 135 Cannon Building Washington, DC 20515 filer information name: Status: State/District:
financial DiScloSure report
Filing ID #10001482 financial DiScloSure report Clerk of the House of Representatives Legislative Resource Center B-106 Cannon Building Washington, DC 20515 filer information name: Status: State/District:
Report Rcqu.ired by the Ethics A0-10. Calendar Year 2003 (5 U.S.C. app. tof.-111). 2. Court or Organization 3. Date of Report
j:,_ Report Rcqu.ired by the Ethics A010 FNANCAL DSCLOSUR REPORT in Government Act of 1978 l/ 004. Ll. Calendar Year 2003 (5 U.S.C. app. tof.111).. Person R
financial DiScloSure report
Filing ID #10000711 financial DiScloSure report Clerk of the House of Representatives Legislative Resource Center B-106 Cannon Building Washington, DC 20515 filer information name: Status: State/District:
[Z NONE (No reportable non-investment income.) D NONE (No reportable non-investment income.) D NONE (No reportable reimbursements.
Martin_Beverly_B FNANCAL DSCLOSURE REPORT Page 2of14 MARTN, BEVERLY B. 611912009 ll. N 0 NNVESTMENT N CO ME. (Reporting individual and spouse; see pp. 1724 of filing instructions.) A. Filers Nonnvestment
D NONE (No reportable positions.)
.. AOIO FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 Rev. /12006 FOR CALENDAR YEAR 2005 (5 U.S.C. opp. JOI-I I/) l. Penon Reporting (last name, ftnt, middle Initial)
[K NONE (No reportable positions.)
AOlO FINANCIAL DISCLOSURE REPOR Report Required by the Ethics in Government Act of 1978 Rev. 112006 FOR CALENDAR YEAR 2005 (5 U.S.C. app. 101-111) Person Reporting (last name, first, middle initial) Court
[Z NONE (No reportable positions.)
O O Rev. 112008 FINNCIL DISCLOSURE FOR CLENDR YER 2007 REPO \o V::d \( Report Required by the Ethics in Government ct of 1978 (5 U.S.C. app. 101-111) 1. Person Reporting (last name, first, middle initial)
financial DiScloSure report
Filing ID #10005442 financial DiScloSure report Clerk of the House of Representatives Legislative Resource Center 135 Cannon Building Washington, DC 20515 filer information name: Status: State/District:
TABLE OF CONTENTS PAGE GENERAL INFORMATION B-3 CERTAIN FEDERAL INCOME TAX CONSEQUENCES B-3 PUBLISHED RATINGS B-7 ADMINISTRATION B-7
STATEMENT OF ADDITIONAL INFORMATION INDIVIDUAL VARIABLE ANNUITY ISSUED BY JEFFERSON NATIONAL LIFE INSURANCE COMPANY AND JEFFERSON NATIONAL LIFE ANNUITY ACCOUNT G ADMINISTRATIVE OFFICE: P.O. BOX 36840,
INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7. STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION
INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7 STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION The Statement of Financial Affairs provides a summary of the debtor's financial history, transactions,
Guide To Your USAA Investment Management Company Brokerage Forms 1099 For Tax Year 2015
Guide To Your USAA Investment Management Company Brokerage Forms 1099 For Tax Year 2015 We are committed to providing accuracy in reporting tax information related to your USAA brokerage account(s) and
Code means the Internal Revenue Code of 1986, as amended.
The American Funds Roth IRA Trust Agreement Pending IRS approval. Section 1 Definitions As used in this trust agreement ( Agreement ) and the related Application, the following terms shall have the meaning
Fixed Indexed Single Premium Deferred Annuity Disclosure SecurePlus Preferred 6, Policy Form 8965NJ(0212) With Rider Form 8967(0411)
Fixed Indexed Single Premium Deferred Annuity Disclosure SecurePlus Preferred 6, Policy Form 8965NJ(0212) With Rider Form 8967(0411) Qualified Annuity Non-qualified Annuity This is a summary document and
Instructions for Form 8938
2015 Instructions for Form 8938 Statement of Specified Foreign Financial Assets Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless otherwise
WASHINGTON UNIVERSITY SCHOOL OF LAW NEW LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP II) (Last updated: January 19, 2015) I INTRODUCTION
WASHINGTON UNIVERSITY SCHOOL OF LAW NEW LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP II) (Last updated: January 19, 2015) I INTRODUCTION To help law students who want to secure employment in low paying public
Howard 457 Deemed IRA Participation Agreement for Deferred Compensation Plan
Howard 457 Deemed IRA Participation Agreement for Deferred Compensation Plan DC-4803 (09/2015) For help, please call 1-877-677-3678 www.howard457.com 1 2 DC-4803 (09/2015) For help, please call 1-877-677-3678
2015 MUTUAL FUND TAX GUIDE
2015 MUTUAL FUND TAX GUIDE Table of Contents Dear Valued Shareholder: The purpose of this tax guide is to provide basic information about the 2015 tax forms you have received or that may be provided later
STATE OF NORTH CAROLINA COUNTY OF FORSYTH YEAR 2015 APPLICATION FOR PROPERTY TAX RELIEF
STATE OF NORTH CAROLINA COUNTY OF FORSYTH YEAR 2015 APPLICATION FOR PROPERTY TAX RELIEF ELDERLY OR DISABLED EXCLUSION (G.S. 105-277.1), DISABLED VETERAN EXCLUSION (G.S. 105-277.1C), or CIRCUIT BREAKER
INSTRUCTIONS FOR COMPLETING THE JUDICIAL FINANCIAL REPORTING STATEMENT APPLICABLE TO MUNICIPAL COURT JUDGES (Pursuant to Rule 1:18B)
REVISED FOR 2004 REPORTING YEAR DEFINITIONS INSTRUCTIONS FOR COMPLETING THE JUDICIAL FINANCIAL REPORTING STATEMENT APPLICABLE TO MUNICIPAL COURT JUDGES (Pursuant to Rule 1:18B) Judge or Self means any
14. Probate in the State of Washington
-63-14. Probate in the State of Washington What Is Probate? Probate is a court-supervised procedure that determines the ownership of property of a deceased person (a decedent). When a person dies, all
Baltimore 457 Deemed IRA Participant Agreement
Baltimore 457 Deemed IRA Participant Agreement NRM-8296MD-BA.2-0314 1 2 Employer Plan IRA Type Personal Information Baltimore Deemed IRA Participation Agreement Payroll Deduction Authorization & Service
Uniform Residential Loan Application
This application is designed to be completed by the applicant(s) with the Lender s assistance. Applicants should complete this form as Borrower or Co-Borrower, as applicable. Co-Borrower information must
Instructions for Form 8938 (Rev. December 2014)
Instructions for Form 8938 (Rev. December 2014) Statement of Specified Foreign Financial Assets Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless
Non-Deductible/ROTH IRA Disclosure Statement
UBS Trust Company of Puerto Rico Non-Deductible/ROTH IRA Disclosure Statement UBS Trust Company of Puerto Rico ( UBS Trust or the Trustee ), as trustee of the UBS Puerto Rico Non- Deductible/ ROTH Individual
Reporting Cash Transactions and Foreign Financial Accounts (Foreign Bank Account Reports "FBAR")
Reporting Cash Transactions and Foreign Financial Accounts (Foreign Bank Account Reports "FBAR") Form 8300 - Reporting Cash Payments Over $10,000 in a Trade or Business Reportable transactions include,
It is important to meet with an experienced elder law attorney who understands the Medicaid rules before making any changes to your property.
230 North Elm Street, Suite 1500 Greensboro, NC 27401 100 Europa Drive, Suite 271 Chapel Hill, NC 27517 336.370.8800 MEDICAID (fax) 370.8830 www.schellbray.com Medicaid is a government program that can
FBAR Background. Reporting Foreign Financial Accounts on the Electronic FBAR
FBAR Background Reporting Foreign Financial Accounts on the Electronic FBAR ROD LUNDQUIST, SENIOR POLICY ANALYST SMALL BUSINESS/SELF-EMPLOYED June 4, 2014 Bank Secrecy Act enacted in 1970 Codified primarily
Lifetime Income Financial Evaluation
Lifetime Income Financial Evaluation Client Name We will hold in the strictest confidence the information collected and entered in this document, other documents, and computerized software programs. We
Fleming, Tawfall & Company, P.C. 2015 Tax Questionnaire
Fleming, Tawfall & Company, P.C. 2015 Tax Questionnaire COMPLETION OF THIS TAX QUESTIONNAIRE, ALONG WITH YOUR SIGNATURE, IS MANDATORY FOR THE 2015 TAX SEASON. Date of Spouse s Date of Name Birth Name Birth
Preparing Family Net Worth and Income Statements
Family and Consumer Sciences FSFCS49 Preparing Family Net Worth and Income Statements Laura Connerly Instructor - Family Resource Management Arkansas Is Our Campus Visit our web site at: http://www.uaex.edu
Personal Retirement Analysis. Jim Sample. for. New Scenario (5/26/2014 4:04:47 AM) Prepared By Neal Frankle Sample Financial Plan
Personal Retirement Analysis for Jim Sample Prepared By Neal Frankle Sample Financial Plan IMPORTANT: The illustrations or other information generated by this report regarding the likelihood of various
Mutual Fund Tax Guide
2010 Mutual Fund Tax Guide TABLE OF CONTENTS Part 1 - Tax Items of Interest... 2-6 Part 2 - Tax Forms... 7-14 Form 1099-DIV...7 Form 1099-B...8 Form 1099-R...9 Form 1099-Q...10 Form 1099-INT...11 Form
Individual Retirement Arrangements (IRAs)
Department of the Treasury Internal Revenue Service Publication 590 Cat. No. 15160x Individual Retirement Arrangements (IRAs) (Including Roth IRAs and Education IRAs) For use in preparing 2000 Returns
Supplement to IRA Custodial Agreements
Supplement to IRA Custodial Agreements Effective December 31, 2014, the update below will be made to the American Century Custodial agreements for the following retirement accounts: Traditional IRAs, Roth
DIVORCE AND LIFE INSURANCE, QUALIFIED PLANS AND IRAS 2013-2015
DIVORCE AND LIFE INSURANCE, QUALIFIED PLANS AND IRAS 2013-2015 I. INTRODUCTION In a divorce, property is generally divided between the spouses. Generally, all assets of the spouses, whether individual,
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES OF BENEFICIAL OWNERSHIP OF SECURITIES
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES OF BENEFICIAL OWNERSHIP OF SECURITIES The Commission is authorized to solicit the information required
Thank you for choosing our firm to prepare your income tax returns for tax year 2014. This letter confirms the services we will provide.
Deborah Wright Keystone Management Services, LLC P.O. Box 965564 Marietta, GA 30066 January 19, 2015 Dear Taxpayer, Thank you for choosing our firm to prepare your income tax returns for tax year 2014.
Uniform Residential Loan Application
Uniform Residential Loan Application This application is designed to be completed by the applicant(s) with the Lender s assistance. Applicants should complete this form as Borrower or Co-Borrower, as applicable.
New York State Tax Relief for Victims of Terrorist Attacks
Publication 59 New York State Tax Relief for Victims of Terrorist Attacks Pub 59 (2/15) Note: A Publication is an informational document that addresses a particular topic of interest to taxpayers. Subsequent
MECKLENBURG COUNTY. Assessor s Office Real Estate Division
MECKLENBURG COUNTY Assessor s Office Real Estate Division Dear Sir/Madam, Enclosed is a 2014 application/audit review for Low-Income Homestead Exclusion, the Disabled Veteran Exclusion, and the Circuit
Proposed Washington Capital Gains Tax HB 1484/SB 5699. Frequently Asked Questions
Proposed Washington Capital Gains Tax HB 1484/SB 5699 Governor Inslee is proposing a capital gains tax on the sale of stocks, bonds and other assets to increase the share of state taxes paid by Washington
ELDER LAW. PLANNING QUESTIONNAIRE (Married) PART A: PERSONAL INFORMATION
Page 1 of 6 ELDER LAW PLANNING QUESTIONNAIRE (Married) Date Home Phone Business Phone PART A: PERSONAL INFORMATION CLIENT HUSBAND: Full Name Birth Date Social Security Number Street Address City Zip U.S.
SECOND MORTGAGE APPLICATION CHECKLIST
SECOND MORTGAGE APPLICATION CHECKLIST First City Credit Union, NMLS# 649182 This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this
Laurel View Village Residential Living Unit Application
Laurel View Village Residential Living Unit Application Couples should complete one set of forms jointly. Leave blank any items that do not pertain to you. Please fill out all items completely as possible,
PRIVATE WEALTH MANAGEMENT THE COMPLETE REFERENCE FOR THE PERSONAL FINANCIAL PLANNER
PRIVATE WEALTH MANAGEMENT THE COMPLETE REFERENCE FOR THE PERSONAL FINANCIAL PLANNER G. Victor Hallman, Ph.D., J.D. Memberof the Pennsylvania Bar and Lecturer, Wharton School, University of Pennsylvania
HEALTH CARE ACT TAX OVERVIEW INDIVIDUALS. Expanded Medicare taxes and other changes make planning critical
HEALTH CARE ACT TAX OVERVIEW INDIVIDUALS Expanded Medicare taxes and other changes make planning critical 1 The agenda The health care act s tax impact on individuals Medicare tax increase on earned income
Property ID Number: Name of Applicant: Date of Birth: Mo Day Yr Date of Death: Mo Day Yr
APPLICATION/AUDIT REVIEW FOR PROPERTY TAX RELIEF ELDERLY OR DISABLED EXCLUSION (G.S. 105-277.1), DISABLED VETERAN EXCLUSION (G.S. 105-277.1C), or CIRCUIT BREAKER TAX DEFERMENT PROGRAM (G.S. 105-277.1B)
Traditional IRA s Contribution rules-
A Traditional IRA is a retirement plan that allows you to save money for retirement. In the case of a traditional IRA, you may also be offered an immediate tax shelter for the contributions that you make
Individual Retirement Arrangements (IRAs)
Department of the Treasury Internal Revenue Service Publication 590 Cat. No. 15160x Individual Retirement Arrangements (IRAs) (Including Roth IRAs and Education IRAs) For use in preparing 1999 Returns
Contractor s Bond Submission Checklist
Contractor s Bond Submission Checklist Please complete the forms for items 1, 3, and 5. If you can not download any of the checked documents, please contact us. 1. *Contractors Questionnaire 2. *CPA Prepared
The Roth IRA. An IRA with a difference. Is it right for you?
The Roth IRA An IRA with a difference Is it right for you? The Roth IRA An IRA with a difference The original IRA was designed to help individuals plan for their retirement by enabling them to make tax-deductible
Notice 97-34, 1997-1 CB 422, 6/02/1997, IRC Sec(s). 6048
Notice 97-34, 1997-1 CB 422, 6/02/1997, IRC Sec(s). 6048 Returns of foreign trusts foreign gift reporting requirements tax This notice provides guidance regarding the new foreign trust and foreign gift
Internal Revenue Service
Internal Revenue Service Number: 200750009 Release Date: 12/14/2007 Index Numbers: 368.04-00, 355.01-00 ---------------------- -------------------------------------------------- --------------------------------------
US Taxpayers Participating in Non US Retirement Plans: When is There an FBAR or FATCA Reporting Obligation?
February 29, 2012 Authors: Anubhav Gogna and David W. Powell If you have questions, please contact your regular Groom attorney or any of the attorneys listed below: Anubhav Gogna agogna@groom.com (202)
USAA SIMPLE/SEP-IRA. Disclosure Statements and Custodial Agreements 49629-1215
USAA SIMPLE/SEP-IRA Disclosure Statements and Custodial Agreements 49629-1215 Table of Contents A. SIMPLE IRA Custodial Agreement 2 B. SIMPLE IRA Disclosure Statement 3 C. SEP-IRA Custodial Agreement 7