[Z NONE (No reportable non-investment income.) D NONE (No reportable non-investment income.) D NONE (No reportable reimbursements.

Size: px
Start display at page:

Download "[Z NONE (No reportable non-investment income.) D NONE (No reportable non-investment income.) D NONE (No reportable reimbursements."

Transcription

1 Martin_Beverly_B

2 FNANCAL DSCLOSURE REPORT Page 2of14 MARTN, BEVERLY B ll. N 0 NNVESTMENT N CO ME. (Reporting individual and spouse; see pp of filing instructions.) A. Filers Nonnvestment ncome [Z NONE (No reportable noninvestment income.) SOURCE AND TYPE NCOME (yours, not spouses) B. Spouses Nonnvestment ncome / you were married during any portion of the reporting year, complete this section. (Dollar amount not required except for honoraria.) D NONE (No reportable noninvestment income.) SOURCE AND TYPE Selfemployed (attorney in partnership) Director fee for Lone Star Corporation JV. REMBURSEMENTS transportation, lodging,/ood, entertainment. (ncludes those to spouse and dependent children; see pp offi/ing instructions.) D NONE (No reportable reimbursements.) SOURCE DATES LOCATON PURPOSE TEMS PAD OR PROVDED l. exempt

3 FNANCAL DSCLOSURE REPORT Page 3of14 MARTN, BEYERL YB. 6119/2009 V, GFTS. (ncludes those to spouse and dependent clrildren; see pp of filing instructions.) D NONE (No reportable gijis.) SOURCE DESCRPTON VALUE. exempt V. LABLTES. (ncludes those of spouse and dependent clrildren; see pp of filing instructions.) [Z NONE (No reportable liabilities.) CREDTOR DESCRPTON VALUE CODE

4 FNANCAL DSCLOSURE REPORT Page 4of14 Name or Person Reporting MARTN, BEYERL Y B. Date or Report 6/19/2009 V. NVESTMENTS and TRUSTS income,.. a1ue, transactions (ncludes those of spouse and dependent children; see PP 3460 of filing instructions.; D NONE (No reportable income, assets, or transactions.) A. B. c. D. l Description of Assets ncome during Gross value at end of Transactions during (including trnst assets) () () () (3) (4) Place "(X)" after each asset. Amount Type (e.g., Value Value Type (e.g., Date Value Gain i. L... (5) dentity of Code Month ; Code 2 Code buyer/seller c."<cmpt from prior disc losurc div., rent, Code 2 Method buy, sell, L_ (AH) or int.) (JP) Code 3 redemption) Day (JP) (AH) (if private. (QW) : L 1. Bank of America checking account A nterest K T 2. Bank of America money market account A nterest K T 3. Bank of America money market account A nterest J T 4. Appalachia Community Bank CD retirement) B nterest 5. Appalachia Community Bank CD retirement) B nterest 6. Bangor Savings CD A nterest 7. Bangor Savings CD A lnt./div. 8. Bank of America Certificate of Deposit A nterest 9. Bank of America Certificate of Deposit L T 10. BankUnited CD 11. Bank United CD B nterest 12. Buckhead Community Bank CD B nterest retirement) 13. Buckhead Community Bank CD (... B nterest 14. Buckhead Community Bank CD ( L T retirement) 15. Buckhead Community Bank CD M T retirement) 16. Capital One Bank Certificate of Deposit B nterest 17. Cathay Bank CD. ncome Gain Codes: A =$1,000 or less B =$1.00 $2.500 c =$2,501 $5.000 D =$5,001 $15,000 E =$ 5,001 $50,000 (Sec Columns B and D4) F =$50,001 $100,000 G =$ $1, H =$1, S H2 =More than $5,000, Value Codes J =$ or less K =$ $ L =$50,001 $100,000 M =$100,001 $ (See Columos Cl and DJ) N =$250,001 $500,000 0 =$ Sl.000,000 Pl =$1,000,001 $5,000,000 P2 =$5,000,001 $25,000,000 PJ =$ $50.000,000 P4 =More than $50, (See Column C2) U =Book Value V =Other W =Estimated J 3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) s =Assessment T =Cash Mark.et

5 FNANCAL DSCLOSURE REPORT Page 5of14 MARTN, BEYERL Y B. 6/19/2009 V. NVESTMENTS and TRUSTS income,.. a1ue, transactions r1nc1udes those of spouse and dependent children; see PP 3460 D NONE (No reportable income, assets, or transactions.) of filing instrucrions.j c. D. Description of Assets ncome during Gross va Jue at end of [ Transactions during A. (including trust assets) 8. _! o n! : r l. ; (} () i () r (3) (4) (5) Place "(X)" after each asset ; Amount Type (e.g., Value : Value [ Type (e.g., Date i Value Gain dentity of : Code exempt from prior disclosure div., rent, Code 2! Method /1 buy, sell, Month J Code 2 Code buyer/seller (AH) or int.) (JP) Code 3 redemption) Day! (JP) (if private L < (AH) 18. Cathay Bank CD B nterest 19. Countrywide.CD retirement) A nterest 20. Countrywide CD retirement) A nterest r 21. Custodial Trust Company (NJ) Certificate of B nterest Deposit 22. Discover Bank Certificate of Deposit A nterest RA) 23. Embassy CD retirement) M T 24. Firstbank CD A nterest L T 25. GE Money Bank CD L T 26. GE Bank CD L T 27. Goldman Sachs Bank CD L T 28. Green Bank CD A nterest 29. Green Bank CD A nterest 30. NG Account A nterest J T 31. NG Account A nterest J T 32. NG Certificate of Deposit B nterest L T 33. M& Bank CD retirement) A nterest 34. M& Bank CD (.. retirement) A nterest. ncome Gain Codes: A =S or less (Sec Columns Bl and 04) F =$50,00t $100, Value Codes J =$15,000 or less (See Columns CJ and 03) N =$ $500,000 P3 =$25,000,001 $ Value Method Codes Q=Appraisal (Sec Column C2) U =Book Value B =$1.001 $2,500 G =$100,001 Sl K=$15,001S50,000 0 =$500,001 Sl.000,000 R =Cost (Real Estate Only) V =Other c =$2.501 $5.000 H =$1, $5,000,000 L =$50,001 $100,000 Pl =$1,000,001 $5, P4 =More than $50.000,000 S =Assessment W =Estimated D =$5.001 $15,000 fl2 =More than $5,000,000 M =$100,001 $250,000 P2 =$5,000,001 $25.000,000 T =Cash Market J

6 FNANCAL DSCLOSURE REPORT Page 6of14 MARTN, BEYERL YB. 6/19/2009 V. NVESTMENTS and TRUSTS income, value, tramactions r1nc1udes those of spouse and dependent children: see PP 3460 of filing instructions.) 0 NONE (No reportable income, assets, or transactions.) A. Dcscriplion of Assets (including lrust assets) Place "(X)" after each asset exempt from prior disclosure r i _L B. ncome during c. D. Gross value al end of () () Amount i Type (e.g.. Value Value! Code div.. rent, Code 2 Method (A H) or int.) (JP) Code 3. (Q W)... l._. _ ( ) Type (e.g., buy, sell, redemption) Transactions during (4) Date Gain dentity of Month! Code buyer/seller Day (AH) (if private i i (5).1.. _... l i! _J 35. MidFirst Bank (Oklahoma) Certificate of Deposit B nterest 36. Morgan Stanley Bank CD L T 37. NANB checking account c nterest M T 38. Pacific Capital CD (RA) L T 39. RBC Centura Bank B nterest K T 40. RBC CD retirement) B lnt./div. 41. RBC CD retirement) B nterest 42. RBC CD retirement) 43. State Bank CD.. A nterest 44. State Bank CD A nterest 45. Sterling Bank CD A nterest 46. Sterling Bank CD A nterest 47. Wachovia checking account D nterest M T 48. Wachovia Certificate of Deposit c nterest 49. Wachovia Certificate of Deposit L T 50. Wachovia Certificate of Deposit B nterest 51. Wachovia Certificate of Deposit. Jncomc Gain Codes: A =$1.000 or less B =$1,001 $2,500 c =$2.50 l $5.000 (See Columns B and 04) F =$50,001. $ G =S $1,000,000 H s1.ooo.001s5,ooo.ooo 2. Value Codes J =$15,000 or less K =$15,001 $ L =$ S (See Columns Cl and 03) N =$250,00 $ O =$ Sl.000,000 Pl =s1.ooo.001. ss PJ =$ $50,000,000 P4 =More than $ Value Method Codes Q =Appraisal R =Cosr (Real Es1a1e Only) S =A ssessment (See Column C2) U =Book Value V =Other W =Estimated.... l D =$5.001 $ E=$15.00l$50,000! 112 =More than $ M =$ $250,000 P2 =$5.000,001 $ T =Cash Markel

7 FNANCAL DSCLOSURE REPORT Page 7of14 MARTN, BEVERLY 8. 6/19/2009 V. NVESTMENTS and TRUSTS income, alue, transactions rrndudes those of spouse and dependent children; see PP 1460 of filing instructions.) D NONE (No reportable income, assets, or transactions.) A. B. C. D. Description of Assets ncome during Gross value at end of Transactions during (including trust assets) ( 1) ( 1) ( () r (3) Place "(X)" after each asset Amount ; Type (e.g., Value Value [ Type (e.g., Date 1 Value Gain dentity of exempt from prior disclosure, Code div. rent, Code 2 i Method buy, sell, Month : Code 2 : Code 1 buyer/seller (AH) or int.) (JP) l Code 3 redemption) Day! (JP)! (AH) (if private L.i. J (4) (5) 52. Wachovia Certificate of Deposit 53. Alliance Fund J T 54. Alliance Fund J T 55. CDCorp 56. CDJCorp 57. CocaCola Company A Dividend 58. Dodge & Cox ncome Fund c Dividend K T 59. Dodge & Cox Stock Fund A Dividend retirement account) 60. Dodge & Cox Balanced Fund A Dividend retirement account) 61. Dodge & Cox nternational Fund c Dividend 62. Dreyfus S&P 500 Fund 63. Evergreen Enhanced S&P (formerly Atlas A Dividend Growth Fund) 64. J. M. & Star, M acon, Bibb County, Georgia c Rent K w 65. Jensen Portfolio CL (RA) c Dividend L T 66. Lone Star Corp. E Dividend M w 67. MCFCorp 68. M& Stable Principal Fund E Dividend 0 T. ncome Gain Codes: A =$1,000 or less B =$1.00 $2.500 C =$2.50 $5.000 D =$5,001 $15,000 E =$ $50,000 (Sec Columns B and 04) f =$ $ G =$100,001 Sl H =Sl, $5, =Mo re than $5,000, Value Codes J =$ or less K=$15,00 $50,000 L =$50,00 $ 00,000 M =$ $ (See Columns Cl and 03) N =$250,001 $ =$500,001 Sl, Pl =$ $5.000,000 P2 =$5,000,001 $25.000,000 PJ =$25,000,001 $50,000,000 P4 =More than $50,000, Value Metho d Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessmen t T =Cash Ma rket (See Column Cl) U =Book Value V =Other W =Estima ted

8 FNANCAL DSCLOSURE REPORT Name or Person Reporting Date or Report Page 8of14 MARTN, BEVERLY B. 6/19/2009 V. NVESTMENTS and TRUSTS income, a1ue, rransa, rions 11nc1udes rhose of spouse and dependent children; see PP 1460 of filing instructions.) 0 NONE (No reportable income, assets, or transactions.) A. B. c. D. Description of Assets ncome during Gross value at end of Transactions during (including trust assets) () Code 1 div., rent, () () (3) (4) (5) Place "(X)" alicr each asset. Amount Type (e.g., Value Value Date Value Gain dentity of exempt from prior disclosure Code 2 Method Month Code 2 Code buyer/seller (A HJ or int.) (J P) Code 3 Day (J P) 1 (AH) (if private (QW) 69. Metropolitan Capital Bancorp RA) L w 70. North Atlanta National Bank A nterest debenture) 71. Fidelity Management nv. Acct. A Dividend K T RA) 72. Pontotoc Bancshares B Dividend K T 73. Schwab money market fund # B Dividend M T 7.4. Schwab value advantage B Dividend M T 75. Schwab Money Market {RA) B Dividend L T 76. Schwab S&P 500 Select B Dividend 77. U.S. Treasury Bonds A nterest 78. Large Cap ndex Fund (Georgia Def. Comp. A Dividend Acct.) 79. WellsFargo C&B MidCap A Dividend TRANSACTONS FOLLOW 81. Assoc. Credit Union money market A nt./div. M T 82. Wachovia Certificate of Deposit B nt./div. 83. BGU Fund RA) 84. BGU Fund... RA) 85. BGU Fund RA) } :;:: : ::000 ; :a l Es:::: l y _f_:_ :_ e ;""_ c = s s s ooo is.o01 s5o:ooo. J 0 $5,00l:si5.ooo. ncome Gain Codes: A 8 $;.ooi.$2.500 (See Columns =s1.oooor1css B t 2. Value Codes and 04) f=$50,00l$ =$100,001$1,000,000 H =$1,000,001$5,000,000 J =$15,000 or less K =$15,001 $ L =$50,001 $100,000 M fl2=morct =$100,001 han$5,000,000 $250,000 (See Columns Cl and DJ) $ 50 :RO T : h 3. (See ValueM Column thodcodes e C2).. = N =$250,001 $500,000 0 =$500,001 $1,000,000 Pl =Sl,000,001 $5,000,000 P2 =$5,000,001 $25,000,000 _j

9 FNANCAL DSCLOSURE REPORT Page 9of14 MARTN, BEVERLY B. 6/19/2009 V. NVESTMENTS and TRUSTS 0 NONE (No reportable income, assets, or transactions.) income, value. rransat"tions r1nc1udes those of spouse and dependent children; see PP 1460 of filing ins1ruc1ions.j A. B. c. Description of Assets ncome during Gross value at end of (including tmst assets) Place "(X)" after each asset exempt from prior disclosure () Amount ; Type (e.g.. Code. div.. rent, (AH) or int.) () Value Code 2 (JP) Value Method Codc3 (QW) () Type (e.g., buy, sell, redemption) D. Transactions during (5) Date dentity of Month buyer/seller Day (if private 86. BGU Fund RA) 87. BGU Fund (RA) 88. BGU Fund.. RA) 89. BGZ Fund RA) 90. BGZ Fund _. RA) 91. BGZ Fund RA) 92. BGZ Fund RA) 93. BGZ Fund RA) 94. BGZ Fund RA) 95. BGZ Fund RA) 96. BGZ Fund RA) 97. BGZ Fund RA) 98. BGZ Fund RA) 99. DA Fund... RA) 100. DA Fund.. RA) 01. DA Fund RA) 02. DA Fund RA). ncome Gain Codes: {Sci! Columns H and 04) 2. Value Codes (See Columns Cl and DJ) A =$1.000 o r less F =$50,001 $ J =$ or l e ss N =$ $500,000 PJ =$25, $50.000,000 u_:n C th er B =$1.00 $2.500 G =$ $ K =$ $ O =$500,001 Sl.000, V alue Method Codes Q=Appraisal R =Cos t (Real Estate Only) L ec u = B oo k V al ". C =$2,50 $5,000 fll =$1,000,001. $ L =$ $100,000 Pl =Sl,000,001 $ P4 =More than $50,000,000 S =Assessment W=Estimated 1 D =$5,001 $15,000 E=$15,00 $50,000 H2 =More than $5, M =$100,001 $ P2 =$5,000,001 $ T=Cash Mar k et 1

10 FNANCAL DSCLOSURE REPORT Page 10of14 MARTN, BEYERL YB. 6/19/2009 V. NVESTMENTS and TRUSTS income. aiue, transactions r1nc1udes those of spouse and dependent children; see PP 3460 of filing instructions.) D NONE (No reportable income, assets, or transactions.) A. B. c. D. Description of Assets ncome during Gross value at end of Transactions during (including trust assets) Place "(X)" after each asset exempt from prior disclosure () Amount ; Type (e.g., Code 1 div., rent, (AH) or int.). L_... (1) Value Code 2 (J.P) Value Method Code 3 (QW) (1) Type (e.g., buy, sell, redemption) f (3) Date Month Day (4). (5) dentity of buyer/seller (if private _J i 103. DA Fund._RA) 104. DA Fund RA) 105. DXD Fund RA) 106. DXD Fund 11 RA) 107. DXD Fund RA) 108. DXD Fund RA 109. DZZ Fund (RA) 110. DZZ Fund RA) 111. FAZ Fund RA) 112. FAZ Fund RA) 113. FAZ Fund RA) 114. FAZ Fund.. RA) 115. FAZ Fund RA),_ 116. FAZ Fund c_ RA) 17. FAZ Fund RA) 118. FAZ Fund RA) 119. FAZFundRA). ncome Gain Codes: A =$ J,000 or Jess B =$1.00 $2.500 C =$2,50 $5,000 0 =$5,001 $15,000 {Sec Columns BJ and 04) F =$50,00 J $ J 00,000 G =$100,001 Sl,000,000 H =S,000,001 $5,000, =More than $5,000, Value Codes (See Columns Ct and 03) 3. Value Method Codes {See Column C2) J =$J5,000 or Jess N =S250,00 $ P3 =$25, $50.000,000 Q =Appraisal U =Book Value K =$15,001 $ =$500,001 $1.000,000 R =Cost (Real Estate Ooly) V =Other L =$50,00 J SJ Pl =Sl $5,000,000 P4 =More than $50, S =Assessment W =Estimated M =$ $250,000 P2 =$5,000,001 $25,000,000 T =Cash Market J

11 L FNANCAL DSCLOSURE REPORT Name or Person Reporting Date or Report Page 11 of 14 MARTN, BEYERL YB V. NVESTMENTS and TRUSTS income... a1ue. transactions r1nc1udes those of spouse and dependent children; see PP J46o of filing instructions.) D NONE (No reportable income, assets, or transactions.) A. B. c. D. Description of Assets ncome during Gross value at end of i Transactions during (including trust assets) i Place "(X)" after each asset xempt e from prior disclosure <) T Code div., rent, c1) 1<2) ()" 1 ci) T (3) ; c4> (5)! Amount : Type (e.g., Value Value Type (e.g., Date f Value i Gain dentity of Code 2! Method i buy, sell, Month Code 2 Code l buyer/seller. 1 ; or inl.) Code 3 redemption) Day i (JP) (AH) (JP) (AH) (if private 1 (QW) L! 1 "...i 120. FAZ Fund RA) 121. FAZ Fund RA) 122. FAZ Fund RA) 123. KBE Fundmt RA) 124. KBE Fund... RA) 125. KBE Fund RA) 126. KBE Fund RA) 127. SKF Fund.. RA) 128. SKF Fund.. RA) 129. SMN Fund RA) SMN Fund RA) SMN Fund.. RA) SMN Fund RA) 133. GE Bank Certificate of Deposit) A nterest 134. Buckhead Community Bank Certificate of Deposit ret.) c nterest 135. Wachovia Certificate of Deposit A nterest 136. Wachovia Certificate of Deposit B nterest. ncome Gain Codes: A =$1.000 or less B =$1.001 $2,500 C =$2,501 $5,000 D =$5.001 $15,000 E =$15,00l : SS (Sec Columns B and 04) F =$ $ G =S Sl =$ $5,000, =More than $5,000, Value Codes J =$ or less K =$15,001 $50,000 L =$ $100,000 M =$ $250,000 (Sec Columns Cl and DJ) N =$250,001 $ =$ $1, Pl =$1, $5, P2 =$5,000,001 $25, _u" n 2 _c_ o _) _ PJ =$25, $50.000,000 u = B v _ e!_ _ ther _ P4 =More than $50.000, Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market.s_e_e_c w_.es_i_im_a_te_d. i... _.J

12 FNANCAL DSCLOSURE REPORT Page 12 of 14 MARTN, BEVERLY B. 6/19/2009 V. NVES Tl\1ENTS and TRUSTS income, alue, transactions r1nc1udes those of spouse and dependent c11i1dren; see PP 1460 of filing instructions.) D NONE (No reportable income, assets, or transactions.) A. 8. c. D. Description of Assets ncome during Gross value at end of Transactions during (including trust assets) (1) (1) (1) (3) (4) (5) Place "(X)" after each asset Amount Type (e.g.. Value Value Type (e.g., Date Value Gain dentity of exempt from prior disclosure Code 1 div., rent, Code 2 Method buy, sell. Monlh Code 2 : Code 1 buyer/seller (AH) or int.) (JP) Code 3 redemption) (QW)...L L Day (JP) (AH) (if private i ; Goldman Sachs Bank Certificate of Deposti A nterest 138. Bank of America Certificate of Deposit A nterest 139. C Certificate of Deposit RA) c nterest 140. MCF Corp (RA) 141. Buckhead Community Bank Certificate of D nterest Deposit ret.) 142. JP Morgan Equity ndex Fund ) K T 143. Buckhead Community Bank M T retirement) 144. Appalachian Community Bank ( RA M T. ncome Gain Codes: A =$1.000 or less B =$1,001 $2,500 c =$2,501 $5,000 0=$5.001$15,000 (See Columns B and D4) F =$50,001 $100,000 G =$100,001$1,000,000 H =$1,000,001 $5,000,000 fl2 =More than $5,000, Value Codes J =$15,000 or less K =$15,001 $50,000 L =$ $100,000 M =S00,001 $ (See Columns Cl and03) N =$250,001 $500,000 0 =$500,001. $1,000,000 Pl =$1, $5,000,000 P2 =$5,000,001 $25.000,000 PJ =$25, $50,000,000 P4 =More than $50,000, Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market L ee Columnc2) U =Book Value V =Other W=Estimated

13 FNANCAL DSCLOSURE REPORT Page 13of14 MARTN, BEVERLY B. 6/19/2009 V. ADDTONAL NFORMATON OR EXPLANATONS. (/ndicateparto/reporl) Part JA Judge. Nonnestement!Ncome Nonnvestment ncome was received during the as U.S. Government salary for services as a U.S. District

14 FNANCAL DSCLOSURE REPORT Page 14of14 MARTN, BEVERLY B. 6/19/2009 X. CERTFCATON. 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 nondisclosure. 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 of5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations. Sign NOTE: ANY NDVDUAL WHO KNOWNGLY AND WLFULLY FALS AND CRMNAL SANCTONS (5 U.S.C. app. 104) FLNG NSTRUCTONS Mail signed original and 3 additional copies to: Committee on Financial Disclosure Administrative Offce of the United States Courts Suite 2301 One Columbus Circle, N.E. Washington, D.C

[Z NONE (No reportable non-investment income.) D NONE (No reportable non-investment income.) [Z NONE (No reportable reimbursements.

[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

More information

[Z NONE (No reportable positions.)

[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

More information

D NONE (No reportable non-investment income.)

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

More information

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

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,

More information

D NONE (No reportable positions.)

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

More information

D NONE (No reportable non-investment income.) [Z NONE (No reportable non-investment income.) D NONE (No reportable reimbursements.

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

More information

September 20, 2007. Re: Dean D. Pregerson, 2006 Financial Disclosure Report. Dear Ortrie D. Smith,

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

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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,

More information

FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2007. U.S. District Court. D Initial. Amended Report. Sb. Reviewing Officer

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)

More information

Person Reporting - A Practical Legal Guide

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)

More information

D NONE (No reportable positions.)

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)

More information

[{] NONE (No reportable positions.)

[{] 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)

More information

D NONE (No reportable positions.)

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)

More information

state Of Pennsylvania Munley, PA Personal/Business Tax Deductions

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,

More information

[{ NONE (No reportable positions.)

[{ NONE (No reportable positions.) 1 AOJO Rev. 112013 Report Required by the Ethics in Government Act

More information

D NONE (No reportable positions.)

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)

More information

[{ NONE (No reportable positions.)

[{ 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)

More information

[K NONE (No reportable positions.)

[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,

More information

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

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

More information

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) 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.

More information

FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2006. U.S. District Court, Mass. D Initial Annual. Amended Report. Sb.

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

More information

[K NONE (No reportable positions.)

[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)

More information

II. AGREEMENTS. (Reporting individual only; see pp. 14-16 of filing instructions.) C- 9 0 _o rn 0 0 NONE (No reportable agreements.

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),..._,...

More information

FOR CALENDAR YEAR 2010 (5 U.S.C. app..~.~" I01-111)

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,

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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

More information

FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111)

FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) O Brien, Terrence L. AO I0 FINANCIAL DISCLOSURE REPORT Rev. 1/2011 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) Report Required by the Ethics in Government Act of 1978 1. Person Reporting (last name,

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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,

More information

UNITED STATES DISTRICT COURT

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

More information

D NONE (No reportable positions.)

D NONE (No reportable positions.) FNANCAL DSCLOSURE REPORT Report Required by the Ethics AO JO in Government Act of 1978 Rev. 112010 FOR CALENDAR YEAR 2009 (5 U.SC. app. JOJ-J 1 ). Peno Reporting (last name. first middle initial) l. Court

More information

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

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)

More information

D NONE (No reportable positions.)

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

More information

D NONE (No reportable positions.)

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

More information

[R NONE (No reportable positions.)

[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,

More information

FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2005. 2. Court or Organization. Wester District of Missouri. Sa. Report Type {check appropriate type)

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,

More information

FINANCIAL DISCLOSURE REPORT. 2. Court or Organization. U.S.D.C. - S.D. Tx. Sa. Report Type (check appropriate type) D Nomination,

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

More information

D NONE (No reportable positions.)

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,

More information

[{ NONE (No reportable positions.)

[{ 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,

More information

D NONE (No reportable positions.)

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

More information

D NONE (No reportable positions.)

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

More information

D NONE (No reportable positions.)

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

More information

D NONE (No reportable positions.)

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)

More information

D NONE (No reportable positions.)

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)

More information

FOR CALENDAR YEAR 2009 (5 U.S.C app. 101-111) 2. Court or Organiz.tlon. United States District Court - District of New Jersey

FOR CALENDAR YEAR 2009 (5 U.S.C app. 101-111) 2. Court or Organiz.tlon. United States District Court - District of New Jersey Kugler, Robert B. AOJO FNANCAL DSCLOSURE REPOR Rev. 1121)/0 FOR CALENDAR YEAR 2009 (5 U.S.C app. 101-111) Report Required by the Ethics in Governmenr Act of 1978 Person Reporting (last name, first, middle

More information

D NONE (No reportable positions.)

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)

More information

financial DiScloSure report

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:

More information

[Z NONE (No reportable positions.)

[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)

More information

financial DiScloSure report

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:

More information

[K NONE (No reportable positions.)

[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

More information

financial DiScloSure report

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:

More information

Denver Tax Group, LLC CHADWICK ELLIOTT 1888 Sherman Street SUITE 650 DENVER, CO 80203 (0) Organizer Mailing Slip

Denver Tax Group, LLC CHADWICK ELLIOTT 1888 Sherman Street SUITE 650 DENVER, CO 80203 (0) Organizer Mailing Slip Denver Tax Group, LLC CHADWICK ELLIOTT Sherman Street SUITE 0 DENVER, CO 00, (0) Organizer Mailing Slip TAX ORGANIZER TO:, FROM: Denver Tax Group, LLC Sherman Street SUITE 0 DENVER CO 00 (0) -0 Enclosed

More information

FILING DEADLINE IS MARCH 1, 2015. Name on Tax Bill: GPIN: Account: GENERAL INFORMATION AND REQUIREMENTS

FILING DEADLINE IS MARCH 1, 2015. Name on Tax Bill: GPIN: Account: GENERAL INFORMATION AND REQUIREMENTS T. Scott Harris, MCR Commissioner COUNTY OF HANOVER, VIRGINIA REACH: REAL ESTATE TAX RELIEF-SENIOR TAX YEAR 2015 Office of the Commissioner of the Revenue PO Box 129, Hanover, VA 23069 Tel: 804-365-6128

More information

in Government Act of 1978 FOR CALENDAR YEAR 2005 (5 u.s.c. app. 101-111) 2, Court or Organizatin NDIL - WESTERN DIVISION

in Government Act of 1978 FOR CALENDAR YEAR 2005 (5 u.s.c. app. 101-111) 2, Court or Organizatin NDIL - WESTERN DIVISION AOlO Rev.112006 FIANCIAL DISCLOSURE REPt0 lpl,..,,,,,,,.,,,; in Government Act of 1978 FOR CALENDAR YEAR 2005 (5 u.s.c. app. 101-111) 1. Person Reporting Oast name, first, middle Initial) REIN, PHIIP G

More information

Baltimore 457 Deemed IRA Participant Agreement

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

More information

financial DiScloSure report

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:

More information

#2." In my 2006 report it was therefore moved to Line 110, the last entry for that brokerage account.

#2. In my 2006 report it was therefore moved to Line 110, the last entry for that brokerage account. UNITED STATES DISTRICT COURT DISTRICT OF MAINE D. BROCK HORNBY DISTRICT JUDGE April 24, 2007 CJ (/ l) r--,, (/ :: C::l> Committee.::0 on Financial Disclosure :::z,, a-

More information

D NONE (No reportable positions.)

D NONE (No reportable positions.) O JO FINNCIL DISCLOSURE REPOR in Government ct of 1978 Rev. 112008 FOR CLENDR YER 2007 (5 US.C. app. 101-111) Report Required by the Ethics 1. Person Reporting (last name, first, middle initial) Court

More information

D-76. District of Columbia (DC) Estate Tax Forms and Instructions For Estates of Individuals Who Died on January 1, 2011 or After

D-76. District of Columbia (DC) Estate Tax Forms and Instructions For Estates of Individuals Who Died on January 1, 2011 or After Government of the District of Columbia Office of the Chief Financial Officer Office of Tax and Revenue D-76 District of Columbia (DC) Estate Tax Forms and Instructions For Estates of Individuals Who Died

More information

Pauley III_William_H

Pauley III_William_H Pauley III_William_H Page 2of11 Name or Penon Reporting PAULEY III, WILLIAM H Date or Report 05/14/2008 III. NON-INVESTMENT IN CO ME. (Reporting individual and spouse; see pp. 17-U of filing instructions.)

More information

Please note: For any return that is prepared while you wait, payment is expected at the time of completion.

Please note: For any return that is prepared while you wait, payment is expected at the time of completion. Your full name: Please answer the following questions as they relate to the year 2013. While this form is NOT required to be completed, you may be eligible for a 5% discount if this checklist is filled

More information

Thank you for choosing our firm to prepare your income tax returns for tax year 2014. This letter confirms the services we will provide.

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.

More information

STATE OF INDIANA. November 14, 2011. Board of Directors Foster Parent Services, Inc. 3798 W. Co. Road 500 S. Vallonia, IN 47281

STATE OF INDIANA. November 14, 2011. Board of Directors Foster Parent Services, Inc. 3798 W. Co. Road 500 S. Vallonia, IN 47281 ` STATE OF INDIANA AN EQUAL OPPORTUNITY EMPLOYER STATE BOARD OF ACCOUNTS 302 WEST WASHINGTON STREET ROOM E418 INDIANAPOLIS, INDIANA 46204-2769 Telephone: (317) 232-2513 Fax: (317) 232-4711 Web Site: www.in.gov/sboa

More information

CHARITY CARE APPLICATION REQUIRED DOCUMENTATION CHECK LIST

CHARITY CARE APPLICATION REQUIRED DOCUMENTATION CHECK LIST CHARITY CARE APPLICATION REQUIRED DOCUMENTATION CHECK LIST Please return the items below if they apply to your situation. Theses items are required to process your application for charity care assistance.

More information

Compromise Application

Compromise Application Compromise Application Before we will consider accepting less than the full amount due, we must receive all of the information requested below. Your documentation will be reviewed and verified. A Revenue

More information

TAX ASPECTS OF MUTUAL FUND INVESTING

TAX ASPECTS OF MUTUAL FUND INVESTING Tax Guide for 2015 TAX ASPECTS OF MUTUAL FUND INVESTING INTRODUCTION I. Mutual Fund Distributions A. Distributions From All Mutual Funds 1. Net Investment Income and Short-Term Capital Gain Distributions

More information

D NONE (No reportable positions.)

D NONE (No reportable positions.) Carney, Cormac J.. OJO*cc; Rev.112,0{1 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,

More information

Variable Universal Life Permanent Life Insurance. Flexible premiums and potential cash value

Variable Universal Life Permanent Life Insurance. Flexible premiums and potential cash value Variable Universal Life Permanent Life Insurance Flexible premiums and potential cash value Why consider a Variable Universal Life Policy? Permanent life insurance protection, plus potential cash value

More information

Howard 457 Deemed IRA Participation Agreement for Deferred Compensation Plan

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

More information

Mortgage Broker / Mortgage Originator Bond Requirements Nationwide

Mortgage Broker / Mortgage Originator Bond Requirements Nationwide Surety One Email: Underwriting@SuretyOne.org Facsimile: 919-834-7039 Mail: P.O. Box 37284, Raleigh, NC 27627 Mortgage Broker / Mortgage Originator Bond Requirements Nationwide AK Mortgage Broker License

More information

FOR ASSISTANCE PLEASE CALL 703-222-8234 TTY 703-222-7594

FOR ASSISTANCE PLEASE CALL 703-222-8234 TTY 703-222-7594 2014 Desiree M. Baltimore, Manager, Tax Relief Section Department of Tax Administration 703-222-8234 taxrelief@fairfaxcounty.gov TTY: 703-222-7594 APPLICATION FOR TAX RELIEF COUNTY OF FAIRFAX DEPARTMENT

More information

1040 US Tax Organizer

1040 US Tax Organizer 1040 US Please enter all pertinent information. If you have attached a government form for an item, check the box and do not enter a amount. WAGES, SALARIES AND TIPS Employer name: Amount 2011 Amount Attach

More information

IN THE COURT OF APPEALS OF IOWA. No. 3-195 / 12-1701 Filed April 10, 2013. Appeal from the Iowa District Court for Scott County, Paul L.

IN THE COURT OF APPEALS OF IOWA. No. 3-195 / 12-1701 Filed April 10, 2013. Appeal from the Iowa District Court for Scott County, Paul L. IN THE COURT OF APPEALS OF IOWA No. 3-195 / 12-1701 Filed April 10, 2013 IN RE THE MARRIAGE OF KIMBERLY K. GRAMPP AND WILLIAM T. GRAMPP Upon the Petition of KIMBERLY K. GRAMPP, Petitioner-Appellee/Cross-Appellant,

More information

Voya Retirement Insurance and Annuity Company

Voya Retirement Insurance and Annuity Company P E R F O R M A N C E U P D A T E Voya Retirement Insurance and Annuity Company CLACKAMAS COUNTY 457(B) DC PLAN Separate Account D Average Annual Total Returns as of: 11/30/2015 (shown in percentages)

More information

IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA. case No. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT

IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA. case No. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA Plaintiff v case No. Defendant DOMESTIC RELATIONS FINANCIAL AFFIDAVIT Section 1 Affiant's Name Spouse's Name Date of Marriage Age Age Date of Separation

More information

UNITED FIRE GROUP 401(k) PLAN (Full title of the plan)

UNITED FIRE GROUP 401(k) PLAN (Full title of the plan) UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 11-K [ X ] ANNUAL REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December

More information

MONTANA FOURTH JUDICIAL DISTRICT COURT MINERAL COUNTY

MONTANA FOURTH JUDICIAL DISTRICT COURT MINERAL COUNTY Name Address City State Zip Code Phone Number FORM #17 MONTANA FOURTH JUDICIAL DISTRICT COURT MINERAL COUNTY In re the Marriage of:, Petitioner, and, Petitioner. Cause No.: Department No. [ ] Wife s [

More information

Investments. To meet your financial goals you will need a plan. Part of this plan is to create a portfolio.

Investments. To meet your financial goals you will need a plan. Part of this plan is to create a portfolio. Investments To meet your financial goals you will need a plan. Part of this plan is to create a portfolio. This portfolio reflects what type of risk you are willing to accept. Within this portfolio, you

More information

Client Tax Organizer Worksheet

Client Tax Organizer Worksheet PAGE 1 OF 7 The asks about pertinent tax items necessary for preparing the most accurate tax return possible. Please answer all applicable questions and attach a statement when necessary for additional

More information

Tax Alpha. Robert S. Keebler, CPA, M.S.T., AEP. Keebler & Associates, LLP 420 South Washington Street Green Bay, WI 54301.

Tax Alpha. Robert S. Keebler, CPA, M.S.T., AEP. Keebler & Associates, LLP 420 South Washington Street Green Bay, WI 54301. Tax Alpha Presented by Robert S. Keebler, CPA, M.S.T., AEP Keebler & Associates, LLP 420 South Washington Street Green Bay, WI 54301 Agenda 1. Five Dimensional Tax System Ordinary Income Rates Capital

More information

ING Life Insurance and Annuity Company and its Variable Annuity Account C ING express VARIABLE ANNUITY

ING Life Insurance and Annuity Company and its Variable Annuity Account C ING express VARIABLE ANNUITY ING Life Insurance and Annuity Company and its Variable Annuity Account C ING express VARIABLE ANNUITY Supplement dated May 6, 2014 to the Contract Prospectus and Statement of Additional Information, each

More information

D NONE (No reportable positions.)

D NONE (No reportable positions.) Ward, Thomas J. AO JO Rev. 112011 FINANCIAL DISCLOSURE REPORT Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.SC. opp. IOI-I I I) I. Penon Reporting (last name, first,

More information

v. No. MARITAL SETTLEMENT AGREEMENT

v. No. MARITAL SETTLEMENT AGREEMENT STATE OF NEW MEXICO COUNTY OF BERNALILLO SECOND JUDICIAL DISTRICT, Petitioner, v. No., Respondent. MARITAL SETTLEMENT AGREEMENT (Husband=s name) and (Wife=s name) are married. We agree to this entire agreement.

More information

FINANCIAL PROFILE. 3601 West Washington Avenue Suite 2 Yakima, Wa 98908 509-966-4811 www.reevesfinancial.net

FINANCIAL PROFILE. 3601 West Washington Avenue Suite 2 Yakima, Wa 98908 509-966-4811 www.reevesfinancial.net H E L P I N G Y O U A C H I E V E F I N A N C I A L G O A L S FINANCIAL PROFILE 3601 West Washington Avenue Suite 2 Yakima, Wa 98908 509-966-4811 www.reevesfinancial.net INVEST Financial Corporation is

More information

financial DiScloSure report

financial DiScloSure report Filing ID #10005530 financial DiScloSure report Clerk of the House of Representatives Legislative Resource Center 135 Cannon Building Washington, DC 20515 filer information name: Status: State/District:

More information

Voya Retirement Insurance and Annuity Company

Voya Retirement Insurance and Annuity Company P E R F O R M A N C E U P D A T E Voya Retirement Insurance and Annuity Company STATE OF NEVADA DEFERRED COMP Separate Account D, Group Annuity Contract Average Annual Returns as of: 05/31/2016 (shown

More information

STATE PERSONAL INCOME TAXES ON PENSIONS & RETIREMENT INCOME: TAX YEAR 2010

STATE PERSONAL INCOME TAXES ON PENSIONS & RETIREMENT INCOME: TAX YEAR 2010 STATE PERSONAL INCOME TAXES ON PENSIONS & RETIREMENT INCOME: TAX YEAR 2010 Ronald Snell Denver, Colorado February 2011 Most states that levy a personal income tax allow people who receive retirement income

More information

TIER 2 ANNUAL AND CANDIDATE PERSONAL FINANCIAL DISCLOSURE

TIER 2 ANNUAL AND CANDIDATE PERSONAL FINANCIAL DISCLOSURE FAQ: COVER SHEET TIER 2 ANNUAL AND CANDIDATE PERSONAL FINANCIAL DISCLOSURE FREQUENTLY ASKED QUESTIONS WHO IS REQUIRED TO FILE A TIER 2 ANNUAL PERSONAL FINANCIAL DISCLOSURE FORM? Elected officials representing

More information

FINACIAL DISCLOSURE REPORT in Government Act of 19'?8 Calendar Year 2003 (5 U.S.C. app. 101-111) i 1 Nominion, Date 1/1/2003

FINACIAL DISCLOSURE REPORT in Government Act of 19'?8 Calendar Year 2003 (5 U.S.C. app. 101-111) i 1 Nominion, Date 1/1/2003 Report Required by the Ethics FINCIL DISCLOSURE REPOR in Government ct of 19'?8 Calendar Year 2003 (5 U.S.C. app. 101111) Person Reporting (Last name., First name, Middle initial) 2. Court or Organization

More information

INVESTMENT STRATEGIES. 10 Tax-Wise Strategies That May Reduce Your Taxes in the Future

INVESTMENT STRATEGIES. 10 Tax-Wise Strategies That May Reduce Your Taxes in the Future INVESTMENT STRATEGIES 10 Tax-Wise Strategies That May Reduce Your Taxes in the Future 10 TAX-WISE STRATEGIES 1. Make tax-deferred investments Take full advantage of tax-deferred investment opportunities,

More information

MONTANA JUDICIAL DISTRICT COURT COUNTY

MONTANA JUDICIAL DISTRICT COURT COUNTY Name Address City State Zip Code Phone Number [ ] PETITIONER/[ ] RESPONDENT PRO SE MONTANA JUDICIAL DISTRICT COURT COUNTY In re the Marriage of:, Petitioner, and, Respondent. Cause No.: [ ] Petitioner

More information

PLEASE NOTE. For more information concerning the history of these regulations, please see the Table of Regulations.

PLEASE NOTE. For more information concerning the history of these regulations, please see the Table of Regulations. PLEASE NOTE This document, prepared by the Legislative Counsel Office, is an office consolidation of this regulation, current to February 1, 2004. It is intended for information and reference purposes

More information

MONTANA JUDICIAL DISTRICT COURT COUNTY

MONTANA JUDICIAL DISTRICT COURT COUNTY Name Address City State Zip Code Phone Number WIFE, PETITIONER PRO SE Name Address City State Zip Code Phone Number HUSBAND, PETITIONER PRO SE MONTANA JUDICIAL DISTRICT COURT COUNTY In re the Marriage

More information

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability P 1.800.962.4238 W www.pensco.com Distribution Request 1. ACCOUNT OWNER INFORMATION Please type or print all information requested below. Required fields are denoted by an * (asterisk). *First Name: *MI:

More information

2014 Tax Organizer. Thank you for taking the time to complete this Tax Organizer.

2014 Tax Organizer. Thank you for taking the time to complete this Tax Organizer. 2014 Tax Organizer This Tax Organizer is designed to help you collect and report the information needed to prepare your 2014 income tax return. The attached worksheets cover income, deductions, and credits,

More information

PENN STATE FEDERAL BUSINESS LOAN APPLICATION

PENN STATE FEDERAL BUSINESS LOAN APPLICATION PENN STATE FEDERAL BUSINESS LOAN APPLICATION Date: Branch: Office: BUSINESS LOAN APPLICATION CHECKLIST Please be sure to include all of the following so that we may process your application as quickly

More information

2013 Income Tax Organizer

2013 Income Tax Organizer 2013 Income Tax Organizer This tax organizer was designed to assist you in collecting information needed for your income tax return. Data from your year 2012 return has been reflected to remind you of

More information