Académique Documents
Professionnel Documents
Culture Documents
AO-IO(WP)
Rev. 1/2007
REPORT
L i?Of\.11 [;'
fV\ .
4. Title
DISCLOSURE
Un.rec-' S q,\-es
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Initial
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Jctr.vo,ry
_____
Annual
6. Reporting Period
Nomination, Date
3. Date of Report
Final
i).e c er b e ;-
3 I I :J cx:i1;
_ Amended Report
8. On the basis of the information contained in this Report and any modifications
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V.
_______
_____
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9-13 of Instructions.)
POSITION
NAME OF ORGANIZATION/ENTITY
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II. AGREEMENTS.
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14-16 of Instructions.)
PARTIES AND TERMS
DATE
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17-24 of Instructions.)
INCOME
$
2
3
B.
$
Spouse's Non-Investment Income - If you were married during any portion of the reporting year, please complete this
section. (dollar amount not required except for honoraria)
D
1
2
IV. REIMBURSEMENTS
--
Date of Report
25-27 of Instructions.)
SOURCE
NONE
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DESCRIPTION
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2
3
4
5
6
7
V. GIFTS.
SOURCE
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28-31
of Instructions.)
DESCRlPTION
VALUE
V I. LIABILITIES.
CREDITOR
32-33
of Instructions.)
VALUE CODE*
DESCRlPTION
of
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4
5
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p1"'$1,ooo,001 $5,Do,ooo
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<- :
' .
Date of Report
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VII. Page 1 INVESTMENTS and TRUSTS -- income, value, transactions (Includes those of
spouse and dependent children. See pp. 3 4-60 ofInstructions.)
NONE
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. . =:<$15,001-'$50,000 . ;,,;
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Name
of Person Reporting
Date of Report
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IX. CERTIFICATION.
I certify that all information given above (including information pertaining to my spouse and minor or dependent children, if any) is
accurate, true, and complete to the best of my knowledge and belief, and that any information not reported was withheld because it met applicable
statutory provisions permitting non-disclosure.
further certify that earned income from outside employment and honoraria and the acceptance of gifts which have been reported are in
.S.C. 7353 and Judicial Conference regulations.
Date
j-/ C/ JD?
T
04.)