Office
|
|
|
- Coral West
- 8 years ago
- Views:
Transcription
1 Name of Person Reporting: Paula M. Carey Current Home Address: Home Phone: Office Phone: Fax Number: N/A Name of spouse residing in household: None Office Name of child(ren) residing in household: None 2. Filer is not a Candidate for office. 3: Positions Held This question indicates the reason you are required to file a Statement of Financial Interests and must be completed. Identify each position you held in 2010 or now hold as a PUBLIC OFFICIAL or DESIGNATED PUBLIC EMPLOYEE and report the AMOUNT of INCOME, by category, derived from each position in If you did not earn any INCOME in any such position in 2010, complete the question, but check the Income Not Applicable box. Agency in which you serve(d) Position Held Dates of Employment Income 1. Probate and Family Court Admin Office Chief Justice 10/1/ Present $100,000 or more 4: Other Government Position(s) Identify any other government position(s) held in 2010 by you and/or an IMMEDIATE FAMILY member (spouse or dependent child) in any federal, state, county, district or municipal agency, whether compensated or uncompensated, full- or part-time. Please review the Instructions which detail the information that should be disclosed. FILER reported no other government positions. 5: Employment and Other Associations with Businesses and Non-Governmental Entities (Including Non-Profit Organizations) Identify each BUSINESS with which you and/or an IMMEDIATE FAMILY member (spouse or dependent child) were associated in 2010 as an employee, or as a partner, sole proprietor, officer, director, or in any similar managerial capacity, whether compensated or uncompensated, full- or part-time. FILER reported no employment or other associations with businessess and non-government entities. 6: Business Ownership/Equity Identify any BUSINESS in which you and/or an IMMEDIATE FAMILY member owned more than 1% of the EQUITY at any time during FILER reported no business ownership/equity.
2 7: Transfer of Ownership/Equity Interests Identify any EQUITY in a BUSINESS (reported in Question 5 or 6) which you transferred to any IMMEDIATE FAMILY member at any time during FILER reported no transfers of business ownership/equity interests. 8: Leaves of Absence Identify any BUSINESS with which you (not an IMMEDIATE FAMILY member) were previously associated and with which you had an understanding at any time during 2010 regarding employment at any future time. FILER reported no leaves of absence. 9: Gifts Identify any GIFTS received by you and/or an IMMEDIATE FAMILY member at any time during FILER reported no gifts. 10: Honoraria Identify any HONORARIUM received by you and/or an IMMEDIATE FAMILY member at any time during Source s Representative Address of Source Affiliation Recipient and Value (Filer Only) Name and Address of Client 1. MBA- Denise Squillante 20 West St Boston MA Member of MBA- Judge Recipient: Filer Value: $250 This was not a client but the MBA (address above) provided accomodations and lunch for Filer because I was speaking at the annual Family Law Conference. 11: Reimbursements Identify any REIMBURSEMENTS received by you and/or an IMMEDIATE FAMILY member at any time during FILER reported no reimbursements. 12: State or Local Government Securities Identify each SECURITY issued by the Commonwealth or any public agency thereof, county or municipality located in the Commonwealth, owned by you and/or an IMMEDIATE FAMILY member with a fair market value in excess of $1,000, as of December 31, 2010, and report any INCOME received by you at any time from such security in 2010, if such INCOME was in excess of $1,000. Please be aware that state employees who own state bonds and county employees who own county bonds may need to file a disclosure of such ownership with the Commission, in addition to disclosure of such ownership here. Please review the Instructions for more information.
3 FILER reported no state or local government securities. 13: Securities and Investments Identify each SECURITY or other INVESTMENT, including the Commonwealth s U-Fund, with a fair market value in excess of $1,000, beneficially owned by you and/or an IMMEDIATE FAMILY member as of December 31, To report SECURITIES and INVESTMENTS held in trust, see Questions Any INCOME received by you at any time during 2010 in excess of $1,000 from SECURITIES issued by the Commonwealth or public agency thereof or county or municipality located in the Commonwealth should be reported in Question 12. Name of Issuer Description of Security Principal Place of Business or State of Incorporation Owner (Filer or Immediate Family Member) Fidelity Investments- Aggressive Growth Fidelity Investmentsbond fund Fidelity Investmentscash reserve Fidelity Investments- Fidelity Fund Fidelity Investments- Growth and Income 14: Business and Charitable Trusts If you and/or an IMMEDIATE FAMILY member had a beneficial ownership interest or served as a trustee of a BUSINESS or CHARITABLE TRUST as of December 31, 2010, you need to answer this question. You are not required to disclose the address of the BUSINESS or CHARITABLE TRUST if it is the same as your current home address. Where applicable, you should answer this portion of the question with Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no business or charitable trusts. 15: Business and Charitable Trust Assets Report all securities and other investments, with a fair market value in excess of $1,000, held in a BUSINESS or CHARITABLE TRUST(S) and beneficially owned by you and/or an IMMEDIATE FAMILY member as of December 31, You are not required to disclose the address of a property held in the BUSINESS or CHARITABLE TRUST(S) if it is the same as your current home address. Where applicable, you should answer this portion of the question with Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no business or charitable trust holdings. 16: Family Trust Assets Report all SECURITIES and other INVESTMENTS, with a fair market value in excess of $1,000, held in a FAMILY TRUST and beneficially owned by you and/or an IMMEDIATE FAMILY member as
4 of December 31, If your home is held in a FAMILY TRUST, report details on the property in Question 22 if it is located in Massachusetts. You are not required to disclose your current home address. Where applicable, you should answer this portion of the question with Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no family trusts. 17: Realty Trusts If you and/or an IMMEDIATE FAMILY member had a beneficial ownership interest or served as a trustee of a REALTY TRUST as of December 31, 2010, you need to answer this question. You are not required to disclose the address of the REALTY TRUST if it is the same as your current home address. Where applicable, you should answer this portion of the question with Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no realty trusts. 18: Realty Trust: Real Assets Report all real property held in a REALTY TRUST and beneficially owned by you and/or an IMMEDIATE FAMILY member as of December 31, You are not required to disclose the address of the REALTY TRUST if it is the same as your current home address. Where applicable, you should answer this portion of the question Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no realty trust property holdings. 19: Business, Charitable and Realty Trusts: Mortgage Obligations Report all mortgages, including home equity and reverse mortgage loans, as of December 31, 2010, on any property held in a BUSINESS, CHARITABLE or REALTY TRUST and disclosed in response to Question 15 and/or 18. You are not required to disclose the address of a BUSINESS, CHARITABLE or REALTY TRUST if it is the same as your current home address. Where applicable, you should answer this portion of the question Home Address. Please review the Instructions which detail the information that should be disclosed. FILER reported no realty trust mortgage obligations. 20: Business, Charitable, Family and Realty Trusts: Purchases/Transfers of in Massachusetts Only Report all purchases by and/or transfers to any BUSINESS, CHARITABLE, FAMILY and/or REALTY TRUST of property located in Massachusetts, which occurred at any time during FILER reported no purchase/transfers of realty trust property in Massachusetts. 21: Business, Charitable, Family and Realty Trusts: Sales/Transfers of in Massachusetts Only Report all sales and/or transfers by any BUSINESS, CHARITABLE, FAMILY and/or REALTY TRUST of property located in Massachusetts which occurred at any time during FILER reported no sale/transfers of realty trust property in Massachusetts.
5 22: Real Owned In Massachusetts Identify any real property in Massachusetts with an assessed value in excess of $1,000, in which you and/or an IMMEDIATE FAMILY member held an interest as of December 31, EXCLUDE: Out-of-state property or property located in Massachusetts held for business or rental purposes. Address of Description of Person(s) Holding Interest Assessed Value (Filer Only) 1. Primary Residence Filer $100,000 or more 23: Business, Investment and Rental Properties Identify any real property with an assessed value in excess of $1,000 as of December 31, 2010, including time-sharing arrangements, regardless of location, held for business, investment or rental purposes, in which you and/or an IMMEDIATE FAMILY member had a direct or indirect interest. held in a REALTY TRUST should be reported in Question 18. EXCLUDE: Properties held primarily for personal or family use. Address of Description of Person(s) Holding Interest Assessed Value and Net Income (Filer Only) 1. Time Share Joint Assessed Value:$5,001 to 10,000 Net Income:N/A 24: Real Purchases Identify any real property located in Massachusetts which was purchased or otherwise transferred to you and/or an IMMEDIATE FAMILY member at any time during Purchases of property held in a BUSINESS, CHARITABLE, FAMILY and/or REALTY TRUST should be reported in Question 20. You are not required to disclose your current home address. Where applicable, you should answer this portion of the question with Home Address. You are not required to disclose your current home address. Where applicable, you should answer this portion of the question with Home Address. You are not required to disclose the name of your spouse or any dependent child(ren). Where applicable, you should answer this portion of the question by indicating the relationship, e.g., Filer and Child(ren), Spouse, Spouse and Child(ren) or Child(ren). FILER reported no real property purchases. 25: Real Sales Identify any real property located in Massachusetts which was sold by or otherwise transferred from you and/or an IMMEDIATE FAMILY member at any time during Sales of real property held in a BUSINESS, CHARITABLE, FAMILY and/or REALTY TRUST should be reported in Question 21. You are not required to disclose the name of your spouse or any dependent child(ren). Where applicable, you should answer this portion of the question by indicating the relationship, e.g., Filer and Child(ren), Spouse, Spouse and Child(ren), or Child(ren). FILER reported no real property sales. 26: Mortgage Loan Information
6 Identify all mortgages including home equity and reverse mortgage loans, in excess of $1,000, outstanding on December 31, 2010, for which you and/or an IMMEDIATE FAMILY member were obligated. If the mortgage loan was for your current home, exclude the original AMOUNT borrowed or owed. You are not required to disclose your current home address. For an IMMEDIATE FAMILY member, do not report the AMOUNTS borrowed and owed. Address of Creditor Name and Address Original Amount Borrowed and Amount Owed Year Due and Interest Rate 1. Primary Residence Salem Five 210 Essex St Salem MA Original Amount: N/A Amount Owed: N/A 5.2% : Mortgage Receivable Information Identify any real property located in Massachusetts on which you and/or an IMMEDIATE FAMILY member held a mortgage as of December 31, Also identify any real property located out-ofstate which was held for business or rental purposes on which you and/or an IMMEDIATE FAMILY member held a mortgage as of December 31, Report the name and address of the mortgagee (the person obligated to you and/or an IMMEDIATE FAMILY member) and the assessed value. If the mortgage is held only by an IMMEDIATE FAMILY member, do not report the assessed value of the property. EXCLUDE: Mortgages on out-of-state property if the property is held primarily for personal or family use. FILER reported no mortgage receivables. 28: Other Creditor Information Identify each debt, loan or other liability, including mortgage(s), home equity and reverse mortgage loans on property located out-of-state, in excess of $1,000, owed by you and/or an IMMEDIATE FAMILY member as of December 31, You must report the loan collateral, which is the property assigned to guarantee payment. EXCLUDE: Any liability of $1,000 or less; installment loans (cars, household effects, etc.); educational loans; medical and dental debts; credit card purchases (other than cash advances); support or alimony obligations; debts owed to a spouse or CLOSE RELATIVE; and debts incurred in the ordinary course of a BUSINESS. Please review the Instructions which detail the information that should be disclosed. FILER reported no other creditor information. 29: Debts Forgiven Identify each creditor who at any time during 2010 forgave any indebtedness in excess of $1,000 owed by you and/or an IMMEDIATE FAMILY member. EXCLUDE: Any debts forgiven by a spouse, a CLOSE RELATIVE, or the spouse of a CLOSE RELATIVE. FILER reported no debts forgiven. 1: I Paula M. Carey certify that: I made a reasonably diligent effort to obtain required information concerning myself and IMMEDIATE FAMILY MEMBER(S); and The information provided on this form is true and complete, to the best of my knowledge. Submitted under the pains and penalties of perjury.( 4/ 21/ 2011)
7 The Following Immediate Family Members declined to disclose information: The Following are the specific Question(s) for which answers were declined by each Immediate Family Member: The following are the specific question(s) which I decline to answer in whole or in part, because I assert the information is privileged by law. The explanation of the basis of your claim of privilege is: N/A
Agency in which you serve(d) Position Held Dates of Employment Income
Name of Person Reporting: Ira Rubenzahl Current Home Address: Information Redacted Home Phone: Information Redacted Office Phone: Information Redacted Fax Number: Information Redacted Office Email: Information
Office Email: daniel.winslow@mahouse.gov;
Name of Person Reporting: Daniel B. Winslow Current Home Address: Home Phone: Office Phone: 617-388-6085 Fax Number: N/A Name of spouse residing in household: Name of child(ren) residing in household:
Office Email: daniel.winslow@mahouse.gov; 2. Filer is a Candidate for the office of State Representative.
Name of Person Reporting: Daniel B. Winslow Current Home Address: Home Phone: Office Phone: Fax Number: N/A Name of spouse residing in household: Name of child(ren) residing in household: Office Email:
Position Held. Position Held. 1. UMass Medical School Faculty Spouse N/A
Name of Person Reporting: Gregory Bialecki Current Home Address: Home Phone: Office Phone: 617-788-3626 Fax Number: N/A Office Email: gregory.bialecki@state.ma.us Name of spouse residing in household:
How To Apply For A Debt Collection License In Massachusetts
Company New Application Checklist Jurisdiction-Specific Requirements MA MASSACHUSETTS DEBT COLLECTOR LICENSE This document includes instructions for a company (corporation location) new application request.
CHARLES COUNTY ETHICS COMMISSION c/o Office of the County Attorney P.O. Box 2150 La Plata, Maryland 20646 301-645-0555
CHARLES COUNTY ETHICS COMMISSION c/o Office of the County Attorney P.O. Box 2150 La Plata, Maryland 20646 301-645-0555 FINANCIAL DISCLOSURE STATEMENT Form 2 Qualifying Employees & Appointed Members of
Instructions for Schedule L (Form 990 or 990-EZ)
2010 Instructions for Schedule L (Form 990 or 990-EZ) Transactions With Interested Persons Department of the Treasury Internal Revenue Service State whether the transaction has been Section references
Form M-433-OIS Statement of Financial Condition and Other Information
Form M-433-OIS Statement of Financial Condition and Other Information Rev. 6/09 Massachusetts Department of Revenue Complete all entries with the most current information available. For entries that do
Instructions for Schedule L (Form 990 or 990-EZ)
2011 Instructions for Schedule L (Form 990 or 990-EZ) Transactions With Interested Persons Department of the Treasury Internal Revenue Service Section references are to the Internal do so, it must file
CAUSE NO. IN THE MATTER OF IN THE DISTRICT COURT THE MARRIAGE OF AND JUDICIAL DISTRICT INVENTORY AND APPRAISEMENT OF
CAUSE NO. IN THE MATTER OF IN THE DISTRICT COURT THE MARRIAGE OF _ AND JUDICIAL DISTRICT _ AND IN THE INTEREST OF, MINOR CHILDREN COUNTY, TEXAS INVENTORY AND APPRAISEMENT OF, Petitioner/Respondent, submits
POLICY OWNERSHIP CALCULATOR
POLICY OWNERSHIP CALCULATOR COMPLETE SUCCESSION POLICY OWNERSHIP CALCULATOR Name of A. DEATH TPD TRAUMA NOTES Funds 100% of Preagreed ASSETS LIABILITIES PERSONAL Accounting Fees Bank Debt Loan Account
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
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
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
INSTRUCTIONS FOR PREPARATION OF DEBTOR'S CHAPTER 11 MONTHLY OPERATING REPORT INDIVIDUAL AND INDIVIDUAL WITH A SOLE-PROPRIETORSHIP
U.S. Department of Justice Office of the United States Trustee INSTRUCTIONS FOR PREPARATION OF DEBTOR'S CHAPTER 11 MONTHLY OPERATING REPORT INDIVIDUAL AND INDIVIDUAL WITH A SOLE-PROPRIETORSHIP Debtors-in-Possession
Important Note: Your 2016 Financial Disclosure Statement ( FDS ) is due no later than May 15, 2016. A $50 per day late filing fee will be assessed.
2016 INSTRUCTIONS: FINANCIAL DISCLOSURE STATEMENT FOR PUBLIC EMPLOYEES Important Note: Your 2016 Financial Disclosure Statement ( FDS ) is due no later than May 15, 2016. A $50 per day late filing fee
Official Form B 22A2 Chapter 7 Means Test Calculation 12/14
Fill in this information to identify your case: Debtor 1 Debtor 2 (Spouse, if filing) United States Bankruptcy Court for the: District District of of (State) Case number (If known) Check the appropriate
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:
[name of organization] CONFLICT OF INTEREST POLICY
![[name of organization] CONFLICT OF INTEREST POLICY](/thumbs/29/13886786.jpg "[name of organization] CONFLICT OF INTEREST POLICY")
[name of organization] CONFLICT OF INTEREST POLICY SECTION 1. PURPOSE: is a nonprofit, tax-exempt organization. Maintenance of its tax-exempt status is important both for its continued financial stability
STATEMENT OF CURRENT MONTHLY INCOME AND CALCULATION OF COMMITMENT PERIOD AND DISPOSABLE INCOME
Form B22C (Chapter 13) (10/05) In re Debtor(s) Case Number: (If known) According to the calculations required by this statement: The applicable commitment period is 3 years. The applicable commitment period
{REMOVE THIS 1 page cover memo before sending to applicant/rp} DIVISION OF WASTE MANAGEMENT & DISTRICT PERSONNEL
MEMORANDUM {REMOVE THIS 1 page cover memo before sending to applicant/rp} TO: FROM: SUBJECT: DIVISION OF WASTE MANAGEMENT & DISTRICT PERSONNEL OFFICE OF GENERAL COUNSEL / OFFICE OF INSPECTOR GENERAL FINANCIAL
INVENTORY AND APPRAISEMENT OF COMMUNITY ESTATE OF THE PARTIES
INVENTORY AND APPRAISEMENT OF COMMUNITY ESTATE OF THE PARTIES 1. Real Property (include any property purchased by contract for deed, such as Texas Veterans Land Board property, property purchased in recreational
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
Inventory and Appraisement of [Name of Party] Community Estate of the Parties
![Inventory and Appraisement of [Name of Party] Community Estate of the Parties](/thumbs/27/12153358.jpg "Inventory and Appraisement of [Name of Party] Community Estate of the Parties")
Inventory and Appraisement of [Name of Party] [Name], [Petitioner/Respondent], submits this inventory and appraisement of all assets and liabilities, community and separate estates, as follows: Community
Centinel Financial Corporation
Centinel Financial Corporation SBA Loan Checklist (Startup Company) Enclosed is a checklist of items needed to evaluate your loan request. 1. Enclose a business plan for your proposed company, describing
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
CLIENT NAME: CLIENT QUESTIONNAIRE - Inventory and Appraisement. Community Estate of the Parties. Current fair market value (as of ): $
CLIENT NAME: CLIENT QUESTIONNAIRE - Inventory and Appraisement. Community Estate of the Parties 1. Real Property (include any property purchased by contract for deed, such as Texas Veterans Land Board
This electronic disclosure form is most easily used with Microsoft operating systems and a personal computer.
This electronic disclosure form is most easily used with Microsoft operating systems and a personal computer. If you are using Explorer: http://www.ethicscommissioner.ab.ca/disclosure/members-mla/ Click
Specializing in Local Business Training & Financing Business Loan Application
Date Received by WWCFDC: Specializing in Local Business Training & Financing Business Loan Application The Wellington-Waterloo Community Futures Development Corporation is a community based non-profit
STATEMENT OF CURRENT MONTHLY INCOME AND MEANS TEST CALCULATION FOR USE IN CHAPTER 7 ONLY
Form B22A (Chapter 7) (10/05) In re Debtor(s) Case Number: (If known) According to the calculations required by this statement: The presumption arises. The presumption does not arise. (Check the box as
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,
CLIENT QUESTIONNAIRE - Inventory and Appraisement. INSTRUCTIONS: We prefer that you type up your answers separately, and just refer to the
CLIENT NAME: CLIENT QUESTIONNAIRE - Inventory and Appraisement. INSTRUCTIONS: We prefer that you type up your answers separately, and just refer to the Question #. You do not have to re-type the question.
UNITED STATES DISTRICT COURT for the District of
Page 1 of 5 UNITED STATES DISTRICT COURT for the District of Plaintiff/Petitioner v. Civil Action No. Defendant/Respondent APPLICATION TO PROCEED IN DISTRICT COURT WITHOUT PREPAYING FEES OR COSTS (Long
Official Form 22A 2 Chapter 7 Means Test Calculation 12/13
Fill in this information to identify your case: Check one only as directed in lines 40 or 42: Debtor 1 Debtor 2 (Spouse, if filing) United States Bankruptcy Court for the: District of (State) Case number
CLIENT QUESTIONNAIRE - Inventory and Appraisement. Community Estate of the Parties
CLIENT NAME: CLIENT QUESTIONNAIRE - Inventory and Appraisement. Community Estate of the Parties 1. Real Property (include any property purchased by contract for deed, such as Texas Veterans Land Board
3. Required Questions (for each debtor), write your answer to each question. Did you meet with your attorney in person before you signed the form?
341 Meeting of Case Number Date 1. Introductory Statement My name is, I represent the Chapter 13 Trustee assigned to your case. Today you will be answering questions about your bankruptcy petition under
Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39 administrative fee: Total fee $274)
B 201A (Form 201A) (12/09) WARNING: Effective December 1, 2009, the 15-day deadline to file schedules and certain other documents under Bankruptcy Rule 1007(c) is shortened to 14 days. For further information,
SOUTH CAROLINA BAR. Bankruptcy and the Law
SOUTH CAROLINA BAR Bankruptcy and the Law There are two kinds of bankruptcy that are commonly used for individuals Chapter 7 and Chapter 13. CHAPTER 7 A Chapter 7 bankruptcy is a liquidation bankruptcy,
Check if this is an amended filing
Fill in this information to identify your case: Debtor 1 Debtor 2 (Spouse, if filing) United States Bankruptcy Court for the: District of of Case number (If known) Check if this is an amended filing Official
The Kreager Law Firm 7373 Broadway, Suite 500 San Antonio, Texas 78209 (210) 829-7722. Estate Planning Information
Estate Planning Information Please complete this questionnaire and bring it with you for your initial consultation with us. Of course, this information will be kept in strictest confidence. A. Husband
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:
About this Client Information Form
About this Client Information Form This is a Family Investors Company Client Information Form. Please read it carefully, as you will select products and services, tell us how you want to communicate with
CHAPTER 2015-42. Committee Substitute for Committee Substitute for Committee Substitute for Senate Bill No. 252
CHAPTER 2015-42 Committee Substitute for Committee Substitute for Committee Substitute for Senate Bill No. 252 An act relating to insurance; amending s. 408.909, F.S.; revising the due date for an annual
FAST Financial Aid for School Tuition Following is the list of questions asked by the FAST program.
FAST Financial Aid for School Tuition Following is the list of questions asked by the FAST program. Applicant Information This information needs to be completed for each student applying for aid. 101 Name
Creditors must stop attempting to collect on unpaid bills the debtor was released from.
Bankruptcy You want to get your money back for a product or service you were not satisfied with, but the company has gone bankrupt. What can you do? How does bankruptcy work? Bankruptcy is a legal procedure
COMPANY INFORMATION. Address: City: County: State: Zip:
MEMBER BUSINESS LOAN APPLICATION TYPE OF LOAN/LEASE: Business Vehicle (Fleet) Loan Equipment Financing Line of Credit SBA Loan Working Capital Loan Commercial Mortgage Amount Requested: Purpose/Use of
The Homestead Act. Questions. and Answers. Massachusetts General Laws, Ch. 188, 1-10. William Francis Galvin Secretary of the Commonwealth
Questions and Answers The Homestead Act Massachusetts General Laws, Ch. 188, 1-10 William Francis Galvin Secretary of the Commonwealth updated 8/1/13 William Francis Galvin Secretary of the Commonwealth
The Florist Credit Union:
The Florist Federal Credit Union BUSINESS LOAN APPLICATION I. GENERAL INFORMATION Applicants Name / Borrower (individual business owner or business name): Tax ID Number: Mailing Address: Contact Person:
B U S I N E S S C R E D I T APPLICATION & AGREEMENT
B U S I N E S S C R E D I T APPLICATION & AGREEMENT In this Application and Agreement, you and your mean each person signing this Application and Agreement. Company is your business identified in this
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH INFORMATION REQUESTED OF HEALTH CARE PROVIDERS APPLYING FOR A LICENSE TO OPERATE A HEALTH CARE FACILITY (APPLIES TO APPLICATIONS FOR INITIAL LICENSURE
Informational Guideline Release
Massachusetts Department of Revenue Division of Local Services Navjeet K. Bal, Commissioner Robert G. Nunes, Deputy Commissioner & Director of Municipal Affairs Informational Guideline Release Bureau of
STATEMENT OF FINANCIAL INTEREST
STATEMENT OF FINANCIAL INTEREST For assistance in completing State/District officials file with: Calendar year covered this form contact: Mark Martin, Secretary of State (Note: Filing covers the previous
BUSINESS EXPRESS LENDING LOAN REQUEST. Thank you for your interest in Fox Chase Bank. In this document you will find:
BUSINESS EXPRESS LENDING LOAN REQUEST Thank you for your interest in Fox Chase Bank. In this document you will find: Commercial Loan Application Personal Financial Statement Form Please complete these
SBA Loan Checklist. Ownership Information. Site Information. Business Information
SBA Loan Checklist Ownership Information Completed Credit Application Completed Personal Financial Statement (for each owner) 3 Years Personal Federal Tax Returns (for each owner) Management Profile (form
BUSINESS LOAN APPLICATION
Legal Name (exact legal name) BUSINESS LOAN APPLICATION Each owner, shareholder, partner or member owning 20 percent or more interest in the business must sign a personal guaranty. A minimum of 1 guarantor
CHRISTMAN & FASCETTA, LLC FLAT FEE AGREEMENT AND HOURLY FEE PROVISIONS
CHRISTMAN & FASCETTA, LLC FLAT FEE AGREEMENT AND HOURLY FEE PROVISIONS, (hereinafter referred to as client or you ), hereby engages the Law Offices of Christman & Fascetta, LLC to prepare and file a Chapter
BUSINESS LOAN APPLICATION
BUSINESS LOAN APPLICATION PROCEDURES Thanks you for your interest in Middleton Area Development Corporation s Loan Program. Our loan process is as follows: 1. Submit a complete application to Middleton
Massachusetts General Laws, Ch. 188, 1-10
Massachusetts General Laws, Ch. 188, 1-10 This webpage has been designed to answer some of the basic questions asked every day pertaining to the Homestead Act. It is not designed to provide any legal advice
Applicant Information
Page 1 of 12 Applicant Information Parent or Guardian Information Prefix First Last test test Middle Suffix Mailing Address 1726 W 25th St City State Zip Los Angeles CA 90018 County of Residence Country
ESTATE TAX RETURN ORGANIZER (FORM 706)
This organizer is designed to assist you, the personal representative, in gathering the information required for preparation of the appropriate estate and inheritance tax returns. Please complete the organizer
CASE NO. I (We) hereby certify under penalty of perjury with regard to all secured consumer debts.
IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF ARIZONA In re: CHAPTER 7 Debtor(s) CASE NO. STATEMENT REGARDING SECURED CONSUMER DEBTS I (We) hereby certify under penalty of perjury with regard
Tax Return Questionnaire - 2013 Tax Year
Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return Questionnaire
QUESTIONS ANSWERS. The Homestead Act Massachusetts General Laws, Ch. 188, 1-10. and. William Francis Galvin Secretary of the Commonwealth
QUESTIONS and ANSWERS The Homestead Act Massachusetts General Laws, Ch. 188, 1-10 William Francis Galvin Secretary of the Commonwealth Wanda M. Beckwith Register of Deeds, Southern Berkshire District updated
STATEMENT OF FINANCIAL INTERESTS
FORM 1 Please print or type your name, mailing address, agency name, and position below: STATEMENT OF FINANCIAL INTERESTS 2015 FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME -- MIDDLE NAME : MAILING ADDRESS
PERSONAL ESTATE PLANNING WORKSHEET PERSONAL AND FAMILY INFORMATION. Name. Address. City State Zip. Phone. Email
PERSONAL ESTATE PLANNING WORKSHEET Name Address City State Zip Phone Email PERSONAL AND FAMILY INFORMATION Date of Birth Social Security Number Marital Status: q Single q Married q Domestic Partners /
UNITED STATES BANKRUPTCY COURT NORTHERN & EASTERN DISTRICTS OF TEXAS REGION 6 MONTHLY OPERATING REPORT
ACCRUAL BASIS JUDGE: UNITED STATES BANKRUPTCY COURT NORTHERN & EASTERN DISTRICTS OF TEXAS REGION 6 MONTHLY OPERATING REPORT MONTH ENDING: MONTH YEAR IN ACCORDANCE WITH TITLE 28, SECTION 1746, OF THE UNITED
3. If you received any interest from a "Seller Financed" mortgage, provide: Name and Address of Payer Social Security Number Amount
Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return Questionnaire
BUSINESS LOAN APPLICATION. Borrower s Name: Telephone #:
Borrower s Name: Telephone #: BUSINESS LOAN APPLICATION 110A Slater Road N.W. Cranbrook, B.C. V1C 5C8 Phone: 250-489-4356 Toll Free 1-800-661-2293 Fax: 250-489-1886 www.cfek.ca 1 LOAN APPLICATION CHECKLIST
NOTICE TO CLIENTS WHO CONTEMPLATE FILING BANKRUPTCY
NOTICE TO CLIENTS WHO CONTEMPLATE FILING BANKRUPTCY The purpose of this Notice and The Statement Mandated by Section 527(b) of the Bankruptcy Code, which you have been provided as a separate document are
BUSINESS VEHICLE LOAN APPLICATION
TFCU Business Vehicle Loan Application - 1 BUSINESS VEHICLE LOAN APPLICATION Thank you for choosing Teachers Federal Credit Union to apply for the financing of your business vehicle. This application is
CURRENT MONTHLY INCOME
Client Questionnaire Section 1 - Basic Information Part A. Name and Address Name: Have you used any other names in the past eight years? No Yes If yes, please list other names used: Telephone Numbers\Email
Home Loans - Type of Access and Password Check
HOME EQUITY LOAN APPLICATION PLEASE TYPE OR PRINT IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked
Filing Chapter 7 Bankruptcy: Where to Start
Filing Chapter 7 Bankruptcy: Where to Start Before you can file bankruptcy, you need to do some things to get ready. This checklist tells you how to get ready. Things you should do before starting on your
EZ BUSINESS LOAN APPLICATION
For Bank Purposes Only: Relationship Manager: Date Application Taken: Direct Mail Ref by Existing Cust Walk-in Other: Advertising Special Program EZ BUSINESS LOAN APPLICATION For commercial loan requests
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCE LENDERS LAW (CFLL) WHO IS REQUIRED TO OBTAIN A FINANCE LENDERS
Business Loan Application
Business Loan Application Thank you for applying to Nymeo. Please fill out this form in as much detail as possible, attach it to the applicable Supporting Information listed in item 8, and return everything
CALIFORNIA SOUTHERN Small Business Development Corporation 600 B Street, Suite 2450 San Diego, California 92101 (619) 232-7771 FAX (619) 232-6743
600 B Street, Suite 2450 San Diego, California 92101 (619) 232-7771 FAX (619) 232-6743 THE FOLLOWING INFORMATION (WHERE APPROPRIATE) MUST BE SUBMITTED TO CALIFORNIA SOUTHERN TO APPLY FOR A BUSINESS LOAN:
Date of Interview: NAME DURATION REASON FOR LEAVING. Marital status: Single Married Separated Divorced Widowed Common Law
Date of Interview: CRAWFORD SMITH & SWALLOW INC. Page 1 531 LAKE STREET, ST. CATHARINES, ONTARIO L2N 4H6 Tel: (905) 937-2100 Fax: (905) 937-7363 Website: www.crawfordss.com Email: css@crawfordss.com APPLICATION
SBA LOAN/ LINE APPLICATION
BUSINESS APPLICANT INFORMATION BUSINESS APPLICATION (If applicant is a holding company, please complete a second application for any operating businesses that will guaranty or be co-borrower.) Legal Name
ESTATE TAX RETURN ORGANIZER (FORM 706)
This organizer is designed to assist you, the personal representative, in gathering the information required for preparation of the appropriate estate and inheritance tax returns. Please complete the organizer
CCCS offers this counseling session face-to-face or by phone; information may also be submitted via Internet:
Springfield Glenstone: (417) 889-7474 Fax: (417) 881-7713 Joplin: (417) 782-6830 West Plains: (417) 256-4082 Pre-Bankruptcy Filing Counseling Client#: (office use only) The Bankruptcy Reform Act, S.256
Bankruptcy. 1. What is bankruptcy?
Helping Older Persons With Legal & Long-Term Care Problems Bankruptcy 1. What is bankruptcy? Bankrupt means filing a petition in federal bankruptcy court asking for protection from those to whom you owe
LAUREN ROSS Attorney at Law 2550 N. Hollywood Way Suite 404 Burbank, CA 91505-5046 Tel.(818) 847-0211 Facsimile (818) 847-0214
LAUREN ROSS Attorney at Law 2550 N. Hollywood Way Suite 404 Burbank, CA 91505-5046 Tel.(818) 847-0211 Facsimile (818) 847-0214 INITIAL CONSULTATION AGREEMENT AND REQUIRED NOTICES Please Note: These documents
Commercial Loan Application
Application For Commercial Loan Application Commercial Loan Date: The information that is required for the completion of this application is needed for the Union Bank to make a valid decision to grant
Trading In Securities Policy
Trading In Securities Policy Approved Date: 28th May 2015 POLICY STATEMENT This policy relates to dealings in securities and other financial products, including Meridian shares and other companies shares.
SUPERIOR COURT OF JUSTICE IN BANKRUPTCY PROPOSAL
SUPERIOR COURT OF JUSTICE IN BANKRUPTCY In the Matter of the Proposal of Orchestra London Canada Inc. Of the City of London, in the County of Middlesex, In the Province of Ontario PROPOSAL I, Orchestra
INFORMATION & INSTRUCTIONS for FILERS
PUBLIC OFFICIALS, LEGISLATORS & CANDIDATES MUST FILE FINANCIAL DISCLOSURES FUNDAMENTAL PRINCIPLES of ALASKA S PUBLIC DISCLOSURE LAW Public office is a public trust that should be free from the danger of
MANDATORY BANKRUPTCY DISCLOSURE
2418 Main St. Vancouver, WA 98660 www.mcaleerlaw.net Telephone: (360) 334-6277 Facsimile: (360) 356-1920 MANDATORY BANKRUPTCY DISCLOSURE IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM
Month of Fiscal Year End Legal Structure q Proprietor q Partnership q Corporation q Cooperative Comments:
Application for Financing Business Information o 100 Application Fee 1.5% Admin Processing Fee on the amount of the loan, if approved Date Received Application # Full Legal Name This business is a q Start-up
12 Business Information (Green Sheet)
Give us COPIES only Clips only - NO STAPLES 12 Business Information (Green Sheet) If you are self-employed, or if you have had income for which you do not receive a W-2, please provide the following: A.
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
CONSULTATION DATE. We are a debt relief agency. We help people file for bankruptcy under the bankruptcy code.** Legal. Name
CONSULTATION DATE We are a debt relief agency. We help people file for bankruptcy under the bankruptcy code.** Legal Name: First Middle Last Social Security No. Spouse s Name: First Middle Last SSN#( if
Tax-Savvy Planning for College Expenses
3/31/14 Tax-Savvy Planning for College Expenses The American Opportunity Tax Credit Remains Available through 2017 If you are a parent with hopes of future college diplomas for your children, you are likely
Bankruptcy Q&A. When filing a bankruptcy there are several different chapters under which you can file:
Bankruptcy Q&A Chapter 7: What types of bankruptcy are available? When filing a bankruptcy there are several different chapters under which you can file: This is the most basic bankruptcy and is available
SCHERTZ BANK & TRUST COMMERCIAL LOAN APPLICATION
SCHERTZ BANK & TRUST COMMERCIAL LOAN APPLICATION LOAN REQUEST Business Term loan Commercial Line of Credit Commercial Real Estate Amount Requested $ Proposed Collateral and Value: Term/Month Business Legal
Please complete and sign this Application, along with any required supplemental forms identified through this application process.
Retail Brokerage Account Application About this Application This is a. Please read it carefully, as you will select products and services, tell us how you want to communicate with us, and agree to certain
PERSONAL FINANCIAL WORKSHEET
PERSONAL FINANCIAL WORKSHEET This is NOT the Personal Financial Statement required for DBE certification and cannot be substituted for the mandatory Personal Financial Statement. This document is intended
Honolulu, Hawaii 96813-5010 (808) 593-2199
Honolulu, Hawaii 96813-5010 (808) 593-2199 BUSINESS BANKRUPTCY -- CLIENT INFORMATION WORKSHEETS DEBTOR JOINT DEBTOR FULL NAME: STREET ADDRESS: MAILING ADDRESS: COUNTY: HOME PHONE: WORK PHONE: FAX (if available)
Public Financial Disclosure A Guide to Reporting Selected Financial Instruments
Public Financial Disclosure A Guide to Reporting Selected Financial Instruments TABLE OF CONTENTS AMERICAN DEPOSITARY RECEIPT 1 CASH BALANCE PENSION PLAN 2 COMMON TRUST FUND OF A BANK 4 EMPLOYEE STOCK
July/December Board of Review 2015
Parcel Number 57- Petition Number City of Wyandotte Application for Primary Residence Poverty Tax Relief (as provided for in Section 211.7u of the Michigan Compiled Laws) July/December Board of Review