10
(S USC app. I I · H o 111 ) o p OILDERT, JOH P UNITED STA TES DIST COURT 5 W 205 4 . Ti ll e (A r icl e Ill J udg e s indicat :l ive or senior strs: 5 . Rcport T )'p (check approp riolc l) J !C) 6. Reprting Period 1 2110 I O t bi o f l info1 cln i n ti Rept a ay t . . . . - . . . - - , .; ·' - - . . œ · . :-] (MPOR.TANT NOTES: T instr\lc t ioos 1 ccom1nyi o g this for !l l US l b e ( o\lowcd . Complete all par, chcc ki _ ng t h e NONE bx f o ech part whre you hav e no rab& in f om'tio n. Sign o le p ag e . - .. I.& ; •: > ;: 'f -- of . " . . .. u.;v:--: - N OF ORNlE R ( PARTS A N IERMS I • "' ' " ' ø - <•-- ( ' ·r ,, · ·-. ( j ,Jtl t = ' , & " 0 ) 9 . ·-s.. - •,,7 - . , I IL AGREEMS. ( cotin& individulll oly;s pp . 14-16 ofhn; instrucalons) p NONE · No reprtable ogmcnU.) A010 Rt_, 1/0 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2004 RtptRtquirtd by t< ttis ia ColUmtt Act o 198 I. P Rg(1 ¹Fir na. ý1idJcia 2. C11 o Ot 3. Da!c fRc n 1nagis1.nncjudges indicce full- or part·ci rnc) 0 No1ator D 10111992 1111204 DISTRICT COURT 1E ACTIVE I 0 io.i G A 0 Fl 7. Cb o Ofc Ads JOI W MAI s mc pad i i i moi tcc v.ih apliclel a ro BEN, l 62812 Reie wing Ofc D L POSITIONS. (i iividu o; spp. 913 fumg .. .. .> q NONE . (o"lpsJ I. 2. I. " % .. :: r: ( Fl - < rn C

Rtrt Rtquirtd by h< tb

Embed Size (px)

Citation preview

(S US.C. app. I I · H o 111 )

o po

OILDERT, JOHN P UNITED STA TES DISTRICT COU R T 5W2005

4 . T ille (Article Ill Judges indicate :.C live or senior starus: 5 . RcportT)'pt (check approp riolc l)J!C) 6. Reporting Period

1 213 112004

I On the basis of lhe informa110R conll.ined in this Report and any

t

. . .. - .... -

-,..o;;.: ·' -- . .. · .

:·:-.] (MP OR.TANT NOTES: The instr\lct ioos 11ccom1>3nyio g this form !l l US l b e (o\lowcd . Complete all part$, chcc k i_n g t h e NON E box: for each part

where you h ave no reponab&e in fom'lation. Sign on lase pag e .

- .. I.& ;:•: >.;:-; 'f.o. --

of

. " . .. .... .o:; :})>--:-: -

NAME OF ORGANl2ATION/ENTJTY

R

(

PARTIES ANQIERMS

I • "' '" ' -r: <•---(J

' · ,,.

· · .,

( j

,Jtl

= ' ,

0

)> 9

..0

·- -· ... - •,;,71'-.•, I

IL AGREEMENTS. ( cportin& individulll only;sec pp. 14-16 offihn; instrucalons)

NONE · No reportable ogrcemcnU.)

A0-10

Rt_., 1/2004

FINANCIAL DISCLOSURE REPORT

FOR CALENDAR YEAR 2004

Rtport Rtquirtd by th< ttbi<s iaCol"UUmt:at Act of 19?8

I. Person Rep0rting(l.as1 First name.. 1iddJcinitial) 2. Co1111 or Organization 3. Da!c fRc n

1nagis1.nncjudges indicace full- or part·cirnc) 0 No11'1inatiori. Date 10/111992 11112004

DISTRICT COURT 1UDGE • ACTIVE IO0 imo.i G> AmwoJ 0 FlDll

7. Cbarnbcn or Office Address

JOI WEST MAIN srn£ET modifications pcrtamina dlacso. i.t is. i.n my opinion. to compfianc.c v.ih applicable and regulalions.

BENTON, ll. 62812 Reviewing Officer Daic

L POSITIONS. (Rep<>rtiog individual only; secpp. 9.13 fumg ....,... ..,.>

NONE . (No "J>Oflabl< positicns.J

I.

2.

I.

"·""' ...

:::0 r:i (') Fl -< rn CJ

Name o( Person Rcportiog Date orRep<>rt

g g

$0!/RCE ANQ TYPE

o

FINANCIAL DISCLOSURE REPORT

Gil.BERT, JOHN P

ill. NON-INVESTMENT INCOME. (Reporting individual and spouse; see pp. 17-24 or filing instructions)

A. Filer's Non-lllvestment Income

b!I NONE .. (No report.able non-invt$tmcnt income.)

SOURCE AND TYPE

I.

51412005

GROSS INCOME nOI spoose'$)

B. Spouse's Non-Investment Io come -(Jfyou were married durin any pOftion of the reportin year, please comple1e lhis section. Dollar amount not required except ft>r honoraria.)

NONE - (Noreportable non-invcsbncnt income.)

1.

JV. REIMBURSEMENTS -transport3tion. lodging. food, entertainment.

(Includes th se co spouse and dependent children. See pp. 2$-27 of instructions.)

li2J NONE · (No such reportable rcirobllIScmc.nts.)

SOURCE

I.

QE.'\CR!PTION

YA! ll£

. Name or Person Rcportilli DmorRcport

Gl!BERT, JOHN P 5/412005

FINANCIAL DISCLOSURE REPORT

V. GIFTS. (lnc:lodcstbo•""'J>OU"31>ddepmdmtchildml St.opp ll·JlofinslluctJoos.)

0 NONE (No such rc:ponable ;ills.) -

SO!!RC!l O!lSCRJrDQN

I.

VI. LIABILITIES. (Includes dl06C ofspousc and dependent chlldre.,, Sec pp. 32-34 of instructions.)

D NONE (No rc:por1Jlblc tiabititie<.J -

CBEPC!'OR MI. Old National Bank

QE.SCRIJ1'00N Mong,geon lnvesuncn1 Property

CODE

Nam e of Pcrso o Rcponing D ate of Report

GILBERT, JOHN P S/41200 5

VII.

A II. c. D . T ransaccioos

reportiog period reporti ag period

( I ) ( 2) (1 ) (2) ( I) ff fl Ol txt:I DJ)l f.100) I 1 .sc.Jowrc

(l) ( 3 ) (4 ) (S) Type Typ< (e.g. Oat Val ..e G ain div. ren t ot Codol

COO.) (l-P ) I M\

1. COM. PEPSICO Div J T see note in Part VIO

2 . COM. HUTION TEL. TR. . B l);v K T

3 . COM. AT&T Div T

4 . COM. WALT DISNEY Div I T p artial sale 2113

s . COM. MFS GV.P L l);v T

6 . COM. FRANKLlN U.S.G. D iv J

7. COM.OLDN ATIONALBANK D Div

8. COM. TEMP. G WTH D iv J T

9 . ROYALTY-UNION O IL Div J T

10. Fl'RS T BANK Jn< J T clo.scd acct 211 9 A

11. OLD NA T JONALBANK· AccounlS lnl J T

12. MEADOW RIDGE · ASSESSEI) VALUE E Rent M s 0

1 3. TIM E S HARES · CANCUN VIV A , MllXICO • A Ren! J R

1 4 . BOND · U. S. TREASURY lnl K T

J S . COM. TCW CONV. l); v J T·

1 6 . COM . B R ISTOL MYERS l);v ,.

17. COM PH IL LIPS P E TROL l); v J T

18. COM AMER.ELEC. POWER Dividend

FINANCIAL DISCLOSURE REPORT

Page I ofS

INVESTMENTS and TRUSTS -income, ,-aiuc, tran>e.al�on., (iDclWcs tll0$C ofdie spouse and depe11dca1 ettiJdrca. Sec Pl'·:M·57 (){filing instruc:tious.)

lncnrtii: dllr"ing Gross ,·;llue 111 cod of during reponillg period Description or AsscU

(iododing tnut a.s:>CU)

Pia "(X) after each asset exempt ftQrn prior diset�urt

AJoouul Code I (A•H) int)

(<.JI. V uc Code2 (J.P)

Value Method

(Q-W)

buy, .stll, merger, redtmpllan)

MoollJ •

Day Code

(A·

ldwtityof buycr/scllet (if priv.l1e transaction)

DNONE (No rq»rla.bk iooome. as:se14,. or trans11dions)

A

A I

I AA

A J

TA

N T

A

A

IA

A

$165,00

7nn9Sl,OOO

B

A

A

A

A

J

I T

NomcorPcnon Rcponing

OUJlE RT, JOHN P

"- .. c.

°""""""" ol A>Mb ._ .. ..,. Ocoss \ .. md "'

c ... """"' .... ..-> -pcnod rcpcniog p<riod

(I) (2) ( I) (2)

Type v .. C<rdc I

islt , )

19. COM AlJ.llTE Dividend J T

20. COM XCEL ENER.OY Dividend T

21. COM S/\RJ\ LEE Divklend l T

22 . NOTE U.S. TR.EASURY ..taut

2J. NOTE U.S. TR.EASURY .. ..... . l T

24. NOTll U.S. TREASUR Y lntc:res c l T

25. COM cmzENS COMM. A Dividend J T

26. OON O Fl!D. N Al' L M1 '0 lrllC l'CS'I J T

27. COM COCA-COL/\ Dividend J T

:!$. COM OEN ELECT A Dividend T

29. COM IBM Oivldcr>d

JO. COM MOTOROL/\ /\ Dividend T

31. COM HPQ (mcra<d C OMPAQ "ilh Hewl<tt· Div idend P-nc kard)

32. COM S EU!OMAN Div iden d T

33. COM EXXON MOBIL A Dividend J

34. COM 3.COM Dividend J

35 . COM TRJCON O UJL /\ Dividend T

36. COM TECO ENERGY /\ O.vidmd T

I. tnwmcK'1 n COOca... /\ •$l , 000 0t l!=ss 8 -s1.001 .. n. soo {:

f "' s.so .. 1.s oo.000 G 0 H J =$ 1,C-00,00l ·S5,0CO. (l()O

l . Value ()Qdiii:;: J - S I S .<ig')<!;rcu K L • .SSO,OOt -SI00.000

N • $250 ,000· S S00, 000 0 0

0.

Date of Report

S/412005

(I) If 9IOl bcmpt mlQI mKIDMll"C (2) (l) (4 )

o.. .. v ... boy, lcll Codo 2 me,-ger,

' I (A· r.dcmpUcor)

0 E • Sll.001-Sl<l, OOO

' 1 ,. 5

Q • Aps"als::J • R s ,.

( Col .. oo.Cl) u • lll,)01:. Valcc v " °' "" y,.r - E$1im:'tod

FINANCIAL DISCLOSURE REPORT Page2 ofS

VD. INVESTMENTS and TRUSTS

Place·peraAcr each asset.exempt ""'°""' (<.., v .... tro." pior ditelo.un: di\', l't(lt. Of C<rdc 2 Method

(A·ll) (l·P) Code-3 (().W)

/\

/\ J

/\

/\ l T

/\

/\

A

/\

l

/\ J T

J

/\ J T

/\ J

T

/\ T

J

l

.-_s1,.so1- ooo

(Sec-Gl.lkunns 01 1111d 04) · s•oe.001.11. 00.000

i.s1J,OOl·SSO. (Su &h1m.t11Cl un(I 03) o . .. ssoo,ooi.s1.ooo.ooo t>J • Sl,00 . 01•$.5,000,-000

Trwac.tlOM ...... t�pcriod

(S)TYP< (<a. Galo ldcnbtyo(

........ . Code buyec/seDcrD•y (J.1 ) (if private

1n cion)

-Sl,001-Sll,OOO fU -Moro 1lw2 SS,000,000 M sSIOO,OOl·SV0, 000 P2 • 5',000.00142$,000,l)QO

1'3 • $25.000,001-SSO.OOO,OOO P4 • SMOfctlmn $ 0,000,000

J. Value 1'oict.hcid Codes JtCott (RciJ £t1Aole Only) •Assc$.(fl:)t0! • Caslw'M111kc'

Name of PCTSOn Rcf!Ming

GILBERT . JOHN P

B. c. D.

Date ofRt{lQrt 51412005

Gross val ue al end of

,_.., period reporting period

( I ) (2) ( I ) (2) ( I ) I DOl CXCll'lpl Tt0t 1.ul 1 &eln<> ll' C (3)

Type Value div . rent. Ot' Method Codc2 isi1 . ) Cod<l

<cdcmptioo )

37. COM ORACl.ll Dividend J T

3 8 . COM MEDITRUS1'CORP Oividend T

39. COM AM. HOME PRODUCTS A Dividend J T

4 0. COM CATERPIUAR Dividend I T

41. COM FT. DEARBORN D ividend T

4 2 . C OM G.M. SllRJES G A Dividend K T

4 3 . COM WAl.MART A Div idend J T

44. COM WESTERN RESOUR Dividend J T

45. COM PlfrNAM V ISTA 13 Dividend K

46 . COM DEL t- COMPUTER 'Di vidend J T

47. COM MICROSOFT A D ividend T

48. BOND SO. ILL HOSP. IntereS-t J T

4 9. COM AMERJCA ONLINE Dividend J T

5 0 . COM CISCO S Y STEMS l)iv idmd J T

51. COM EASTMAN KODAK Dividend J T

52. COM PtJfNAM GWBA!. Interest T

53. COM REGIONS FINANCIAL CORP ( f/k/a U n ion A Dividend J T

54. COM MUNDER FUND B Dividend T

9'1n:c :. -:S!.O?OocJe� -- s ,OOJ-S:ts,ooo ::

·, .. (Soc c.1. .. a:i #<' Dj) F" • sioio•·S lo0,000 : c; • $100,001-Sl .OOO, - .fn "' ! OO.OO f ·Sl,000.0\)0 J HJ ·• 1'! ... tbao l,OOO,°'!<' ; 2; Vl!luee d 4 .. , : ... < :--J , =:$is.Ooo·qr1 .. ·K = i ls.001-$ 0.6oo ;:l . - 9;c,o1 'S( QQ,o. ? ;= ; :s,09,001-s;sp, --

and : .tf-:ti ::·: · i• : · : ": '"Pl Z-.s2s.ooo .001:.sso.aoo,ooo.. : · - · P4 i. sbt1oR b .in S SO,ooo.ooo 1 •.. , t Z.

. I 1 ., ' . • ' , I

' !J ,;Yaluel>iJ; bOd eoocs' .: . Q • Ajipfaisal , . R. .. Cost (Real?Sute Onl} S '"' As!lef lll T .... . rkd

: • · ; !( te COi ) j::Or •• u ' !- Valu ·: v: . _ ... Oihcf ,

W. v Estim:Ltcd .1·.

(4) (S) Gau. Code I ( A· "'

(iocll.tdin.gtrust asscu)

(2)P e"(X)" after each asscc exe1t1p1 ""'"""' (e.g. Value Valuo T}'pe (e.g. Da.te:from priordisdosw� Codd. Codc2 ti.y, sell, Momb·

(A·H) (J.P) (Q-W)

l!lllefgef, Doy (l-P)

A

A J

A

A J

A

T

A

J

A

A

A

A

A J

Planters)

A J

' I! :, 1;. e $1 : _

:1; ;• {See Coh1;;CJ 03)nN' "" S isO J o()():.$500 . 000 .. 0 SS00.0Qt-i1,b00,000 st :o oo. 091 . s s.Ooo ,-0 0 0 · P?i;.,.ss.''5 .001: s_..090;000

Tdcruiryof

bqyer/scDcr(ifpriva:ctral'ISaC'tion)

FINANCIAL DISCLOSURE REPORT Page3 ofS

A. Jn.O:'IOIC 41ri11g ir.altS:)(:liOn3 during r(l)()lt£t:ig period Ocsctipcfoo of As$els

= 001- S · l OJ·S .ooo: · o

)

N>me of Perron Re\)O!ting GILBERT, JOHN P 51412005

VII. lNYESTMENTS and TRUSTS - ..-•. '"""'- ...,.. . ,.,, fwcludcs ""' " ortbc spo use ""' ••P<•"'" e bit<J=. Sec""· 3 • - s 1 or filing """"'" J

A. n. c. o.

reportiAg pe riod (I) {l) (I) (2) ( I) J llOC cxcmpc fro m disclosu re

(3) T>1'< u Va!ue:

Cod< l int.) merger, (J·P)

SS. COM FORD Dividend ) T

S 6 . COM AVAYA INC A Dividend T

S1. COM AWE A D ividend sold 6116

S8 . COM EMC D ividend J T

59. COM MIRANT CORP D i vidend ) T

60. COM TYCO A Dividend J T

61. COM PALM ONE (n:une cb31lge from P>lm) A Cnterest J T

62. COM ZIMMER. H OLDINGS Dividend

6 3 . BONO BK OF AMERICA Interest J T

64 . BON D LAQUJNTA lnteresl l T

65 . COM YUM BRANDS (spioo()ff o f Pepsico) A Int erest l T

6 6 . COM HARLEY DAVIDSON fntercst l T bu y 51 1 0

67. BONO CHI IL L/IKE FRONT lntereSL l T

6 8 . NOTES GMA C Dividend sold 6116 J

6 9 . DONO FORD MOTOR Interest T

70. COM AGERE S YSTEMS (spin· off of lucent) Interest J T

7 I. COM COMCAST CORP (>i>in-off of AT&l) Interest J · r

72. COM VERIZON COMM Intere s t J T

l. J,qcarl'lc/Gaif' C : , ' ;A: •SJ. ot loc!t ; fl S1_.00l·S2.50 0 c.: "'.S2:SOJ·S5,0l':!(h '. l) • SS,0ol- 1S1000 , ;. . ,

- ; •(See · ·\ Bl d ) ' r, t : s 1 0,-091.s10o.oOo ; l . G c SJ00,001..SJ.OOO,OOD • . i! JU "' IJ!OO.OOl,S5_, 0Cl9 \ 000. H2 <>:" iiwi s .ooo.<f!o : ?----J. ·:·:. : ·SIStOOI

;so.ooo ;:

;;:-.; n;e e;COl \1UU:.S: c1 aoaru) . t-t : - Slso,o oo:ssoo. ooo · - . 0C=- ssoo.00L..S 1.ooo,ooo = Pl .. s1.«iSQ.001.ss :ooo.ooo - P2 -S5.ooo.001.s 2s.ooo.Qdo

'. : · :;·· ' P3 ; - Q5.0 00, 0.QIM OO OOO..

. ;_'.!' SMotedfsnSS0,000, 01)()

:.1 i :1v MclhOd Ccid Q i•AW <"; ·• . ;: . : R • CO$t(Rea.IEsr.aLe » . s. : /\.1.'>Cs.menr; - " . ) .. ·u ... . _, . ·

. ::j:·Y J ..-..iL:.._: .. ' ' :! · ; . - in>.atC d .; .! ',, (Sce Cojl"1Jt)C2 • · ' · ..• •· Book:'( !"'. ' v . . . "'·

T

( 4 ) ( l ) 0-aiia Cod< I (A• "'

see no<e in Patt vm

Code I div, n::nt, or Code 2 l\.fdbod b\ry. s ell. M<.>nth· (A·H) (l·P) Codd

(Q-W) Day

«d<mpOOo)

A

buycr/scUcr(ifpriv:itcltM.\aelion)

. FINANCIAL DISCLOSURE REPORT Page4 ofS

Date ofRCjl()rt

O«t:ripeion ofA.uets 1Doon1e dl.rina Gross ·;dueat end of T c:fiocscfunn3 reporting period

tepocting petiod (inclt>diug tn1$l asseu)

(l)Place �(Xr alter each asS1Ct excmpc ""'-· (e.g. Val e Valot Typ• (e.g. Datr:-from prior dise�wc

l

l

A

A

A J T

A

A

A l

A

A

A J

A

A

A

!/ :;y i ;. ; $ Se_O� rl�---::.. .•• = 1 ..s_5Qio ..sl00.ooo < :::$100.00 P·?P9 '

,,._; , '.. ;·.

ldcotity of

Namc of Pcoon Reporting GllBERT, JOHN P

Oitc of Report

$1412005

Vll. INVESTMENTS and JRUSTS - "' """ " "" . _,.;..,. <"'"""'' '"'"' •' "" '""'"' ao<1 .i.peodem chi t dtcft. s.. w . :M -i 1 orroling "'""";• ... J

A.

73. COM AMERICAMOVU..

74. COM LUCENT

7 5 . COM DTE ENERGY

76. C O M SOUTHERN CO MPAN Y

77. COM AES

7 8. COM TELEFONOS

7 9 . COM ADESA INC. (spin-off of Allete)

f. 11 Codes: A • Sl.OOO ot J ( SOe"Co!l unns Bl and 04) P =SSO,o6t .. $100,000

2 . ValuCCod.c:s I . -SI S,(!OO o rli;:ss. • 1 ' /Set"Cotumris C J ·and 03) N : ,.. S2so,OOO-S5,00,000 . ; t .,t , 1 I • t t , ! ·· ; • ; • - ..0 S2S ,000,00L - SS0,000 ,000

(Sc:c Colu.M c:!) U a- Book VJ!uc

c. D • Grou; value M cod o (

""°""" period ""°""'' period (I) (l) (I) (2) (I ) I DOC ex ((llfJC fiom diJcloSIJfe

(J) (4 ) ,.,,,. Val"' v.ru. ():liz:i .. tooth. Code2 Code boycr/sclkr

1 (A• (ifpri .. -aic redemption) trul..UCCiM)

Interest I T

A ln<=st T

tn1ercst J T

A Interest I T

lntertS-t

A lntttcst T

A Interest J T

9 • Sl,OOl-S2, SOO 0 • $ 100.001.Sl.OOO,OOO K · s1s.001.sso,ooo

' Hl == $1,000.00J-SS ,000,000

. - t. -- sso.001-StOO, OOC> (,> • SS00,001-Sl,000,000, , Pl • $1 ,000,001-SS,OOO.OOO

sec note in Part YID

see note in Part

YID

tee OOIC in Patt vw

ste noce in Part YID

sec note in Part VOi

s ee note in Part

vm

. .0 • ss.OOl·SIS.000 F. "" S U ,001 -SSO,QOO • J:fl • t.iore ·than S S .000,000 r _,, -

M • $ 100,00t-lliO,OOO :: · . . P? · f SS,OOO OOl·S2$,000,00Q .... . "'· ' ' , . · N • SMore llwl S l 0,000,000

. ' . . . . · ,.

v • 00..

. FLNAl'(ClAL DISCLOSURE REPORT Page 5 ofS

Description of Assets (ioeWog""" """')

l'laee"(l()" aAe<...o ..... ....,.. &oio pri«disc

••lncocie duriog frat,l$lldion1 durinr: rcportina period

(l) (l)""'°""' {e.&- Vallie l'ype (e.g. l).u" ldeociiy or Code I div. rent or Code2 Metl>od buy.sell,

O·P) Code3 ""'lC'· Doy(A ·H) inL) (J·P)(Q-W) "'

A

J

A

A J T

J

3. Vol"' M..oodCodes Q =Apptaisal R •Cost El™e Only) S • �t-t1t

N""" of Pcoon Reporting l)a. te of R1:pot1

2004 . .

FINANCIAL DISCLOSURE REPORT

GllBERT. JOHN P

VIll. ADDITIONAL INFORMATION OR EXPLANATIONS

VII. P. I , item I • Pepsico"'"JS listed as "sold"' in 2003 report and should have been !isled u •partj.a.J s:alc." 1bc value code wa.s J and method was 'tin2003.

VU. pp. 4-S, items 72 - 78 w.re listed as "sold"in the 2002 repon and ll1cy _. d<leted from the 2003 report. They should h>vc been lisicd as "p>ttial sale:," wilh the val-uc md method codes for an ofthese in 2003 being J and T rcipcc.tivdy. Judge Gilbert's 2003 and 2004 contlicc chcckhst still contained these invcs11nent items_, and thc:rc were no conflicts th.al arose in rta,o.rds to lhC$e ite:tN in 2003 and

Date of Rtp<lrt Name of Person RqxirtingFINANCIAL DISCLOSURE REPORT

GIUlERT, JOHN P 514120-05

IX. CERTIFICATION.

I certifythat 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 myknowledge and belief, and that any information not reported was withheld because it met applicable statutory provisions permitting non-disclosure.

I further certify that earned income from outside employment and honoraria and the acceptance of gifts which have been reported are in compliance with the provisions of 5 U.S C. §SOI et. seq., 5 U.S.C. § 7353, and Judicial Conference regulations. .

Signature Date

NOTE: D WILFULLy FALSIFIES OR FAILS TO FILEnus REPORT MA y BE SUBJECT TO CNIL AND CRIMINAL SANCTIONS (5 U.S.C. app. § 104)

FILING INSTRUcnONS

Mail sigued original and 3 additional copies to:

Committee on Financial Disclosure

Administrative Office ofthe United Scates Courts

Suire 2-301

One Columbus Circle, N.E.

Washington, D.C. 20544