Professional Documents
Culture Documents
Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111)
Nomination, [] Initial
7. Chambers or Office Address Suite 7270, 700 Grant Street U.S. Courthouse Pittsburgh, PA 15219
8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable laws and regulations. Reviewing Officer Date
IMPORTANT NOTES: The instructions accompanying this form must be followed. Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.
POSITION
I. Director 2. 3. 4. 5. Custodian
NAME OF ORGANIZATION/ENTITY
Boys and Girls Club of Western Pennsylvania Account # 1
II. AGREEMENTS. tRe, oning i.aiviauot onty; see pp. t4.t6 ol~nng instructions.) [~] NONE (No reportable agreements.)
DATE
I. 2002 2. 2003 3.
Cercone, David S.
IlL NON-INVESTMENT INCOME. (Repo.ing individual and spouse; seepp. 17-24 of filing instructions.)
A. Fliers Non-Investment Income ~~ NONE (No reportable non-investment income.) DATE
I. 2010 2. 2010 3. 4.
INCOME
(yours, not spouses)
$14,200.00 $34,966.00
B. Spouses Nondnvestment Income - if you were married during anyportlon of the reporting year, complete this section.
(Dollar amount not required except for honoraria.)
I. 2010 2. 3. 4.
DATES
LOCATION
PURPOSE
~]
1. 2. 3. 4. 5.
VI. LIABILITIES. a,,a,,,~s ,hos, o/seo~se ~.~ aeee,,,t~,,t chUar~,; s,, ~,,. ~:-~ of filing instructions,)
[~] NONE (No reportable liabilities.)
CREDITOR Chase Home Finance 2. 3. 4. 5. Allegheny Valley Bank of Pittsburgh
DESCRIPTION
Mortgage on Rental Property Naples, FL (Pt. VII, line 17) Bank loan
VALUE CODE M J
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; see pp. 34-60 of fillng instructions.)
[~] NONE (No reportable income, assets, or transactions.)
A. Description of Assets (including trust assets) Place "(X)" after each asset exempt from prior disclosure B, Income during reporting period (l) Amount Code I (A-H) (2) Type (e.g.. div., rent, or int.) C. Gross value at end of reporting period (1) Value Code 2 (J-P) (2) Value Method Code 3 Transactions during reporling period
(2) (3) (4) Date Value Gain mm/dd/yy Code 2 Code 1 (J-P) (A-H)
(s)
Identity of buye~seller (ifprivate ~ansaction)
(Q-W)
I. 2. 3. 4. 5. 6. 7. : 8. I 9. 10. I!. 12. 13. 14. 15. 16. 17. Delaware Tax Free PA Mutual Fund Davis NY Venture Mutual Fund Citizens Bank Accounts American Balanced Fund 529B American Funds Cash Mgt Trust of America-529B IRA - American Funds: Bond Fund of America - American Funds: Capilal Income Builder -American Funds: Income Fund of America -American Funds: Cash Mgt. Trust of America American Funds: Income Fund of America Wachovia Bank: Bank Deposit Sweep Money Market Rental Property, Naples, FL (8/11/2003 $265.000) A A D Dividend Interest Rent J J N T R A C A B A D Dividend Dividend Interest Dividend Dividend Dividend K K K J J M T T T Sold (part) 12/17/10 J A
I. Income Gain Codes: (See Columns BI and D4) 2. Value Codes (See Columns C I and D3 ) 3. Value Method Codes (See Column C2)
A =$1.000 or less F =$50,001 - $100.000 J =$15.000 or less N =$250,001 - $500,000 P3 =$25,000.001 o $50.000.000 Q =Appraisal U =Book Value
B =$1,001 - $2,500 G =$100,001 - $1,000,000 K =$15,001 - $50.000 O =$500.001 - $ 1,000,000 R =Cost (Real Estate Only) V ~ Other
C =$2,501 - $5.000 HI =$1,000,001 - $5,000,000 L =$50,001 - $ 100.000 P I =$1,000,001 - $5,000,000 P4 =More than $50,000.000 S =Assessment W =Estimated
D =$5,001 - $15,000 H2 =More than $5,000.000 M =$100,001 - $250,000 P2 =$5,000,001 - $25,000.000 T =Cash Market
E 3515.001 - $50,000
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. 1 further certify that earned income from outside employment and honoraria and the acceptance of gifts which have been reported are in compliance with the provisions of 5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations.
Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544
Rev. 1/2oz l
Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111)
5b. [] Amended Report 7. Chambers or Office Address 8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable laws and regulations. Reviewing Officer Date
IMPORTANT NOTES: The instructions accompanying this form must be followea~ Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.
D
1. 2.
POSITION
Director Custodian
NAME OF ORGANIZATION/ENTITY
Boys and Girls Club of Westem Pennsylvania Account # !
Cercone, David S. A
III. NON-INVESTMENT INCOME. (Reporting individual and spouse; see pp. 17-24 of filing instructions.)
A. Filers Non-Investment Income
~ NONE(No reportable non-investment income.) DATE
I. 2010 2. 2010 3. 4.
INCOME
(yours, not spouses)
$14,200.00 $34,966.00
B. Spouses Non-Investment Income - if you were married during anyportion of the reportingyear, complete this section.
(Dollar amount not required except for honoraria.)
~-~
1. 2010 2. 3. 4.
DATES
LOCATION
PURPOSE
V. GIFTS. ancludes those to spouse u.d dependent children; see pp. 28-31 of filing instructions.)
NONE (No reportable gifts.)
SOURCE 1. 2. 3. 4. 5. DESCRIPTION
VALUE
VI. LIABILITIES. ancludes those of spouse and dependent children; seepp. 32-33 of f!ling instructions.)
[~] NONE (No reportable liabilities.) CREDITOR Chase Home Finance 2. 3. 4. 5. Allegheny Valley Bank of Pittsburgh DESCRIPTION Mortgage on Rental Property Naples, FL (Pt. VII, line 17) Bank loan VALUECODE M J
VII. INVESTMENTS and TRU STS - i.comc, vatue, transactions (Includes those of spouse and dependent children; see pp. 34-60 of filing instructions.)
D NONE (No reportable income, assets, or transactions.)
A. Description of Assets (including trust assets) Place "(X)" after each asset exempt from prior disclosure B. Income during reporting period (1) Amount Code l (A-H) (2) Type (e.g., div., rent, or int.) C. Gross value at end of reporting period (l) (2) Value Value Code 2 Method (J-P) Code 3 Transactions during reporting period
0)
Type (e.g., buy, sell, redemption)
(2)
Date
(3)
Value
(Q-W)
I. 2. 3. 4. 5. 6. 7. Delaware Tax Free PA Mutual Fund Davis NY Venture Mutual Fund Citizens Bank Accounts Account #1 (Custodian) -American Balanced Fund 529B -American Funds Cash Mgt Trust of America-529B IRA B A D Dividend Dividend Dividend J J M T T T Sold (pan) 12/17/10 J A A C A Dividend Dividend Interest K K K T T T
8. - American Funds: Bond Fund of America 9. 10. 11. 12. 13. 14. 15. 16. 17. - American Funds: Capital Income Builder -American Funds: Income Fund of America -American Funds: Cash Mgt. Trust of America American Funds: Income Fund of America Wachovia Bank: Bank Deposit Sweep Money Market Rental Property, Naples, FL (8/11/2003 $265.000) U.S. Savings Bond A A D A Dividend Interest Rent Interest J
J
T
T R T
N J
I. Income Gain Codes: (See Columns B I and D4) 2. Value Codes (See Columns CI and D3) 3. Value Method Codes (See Column C2)
A =$1,000 or less F =$ 50,001 - $ 100,000 J =$15,000 or less N =$250,001 -$500,000 P3 =$25,000,001 - $50,000,000 Q =Appraisal U =Book Value
B =$1,001 - $2,500 G = $100,001 - $1,000,000 K =$15,001 - $50,000 O=$500,001 - $1,000,000 R =Cost (Real Estate Only) V =Other
C =$2,501 - $5,000 H 1 =$1,000,001 - $ 5,000,000 L =$50,001 - $100,000 PI =$1,000,001 -$5,000,000 P4 =More than $50,000,000 S =Assessment W =Estimated
D -$5,001 - $15,000 H 2 =More than $5,000,000 M $100,001 - $250,000 P2 $5.000,001 -$25,000,000 T =Cash Market
E =$15,001 - $50,000
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. 1 further certify that earned income from outside employment and honoraria and the acceptance of gifts which have been reported are in compliance with the provisions of 5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations.
NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES OR FAILS TO FILE THIS REPORT MAY BE SUBJECT TO CIVIL AND CRIMINAL SANCTIONS (5 U.S.C. app. 104)
Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544