OGE Form 278 (Rev. 12/2011)
Executive
Branch
Personnel
PUBLIC FINANCIAL DISCLOSURE REPORT
Form Approved:
5
C.F.R Part 2634OMBNo.
3209·0001
U.S. Officeof GovernmentEthics
Date of Appointment, Candidacy, Election,
Calendar YearTermination TerminationDate
(If
Appli-
ncumbent
New Entrant,
~ - , , ~ - , - ~ . , ~ -
'Month. Dav.Year)
Covered by ReportNominee,
or
'5(l
Filer
rble)
Month,Day,
Year,
n
Candidate
~
II
Last Name,
First
Name
and
Middle
Initial
ReportingIndividual'
s N
arne
Romney'
;iIW;Mitt
.
I
.
Title
of
Position
i
Department
or
Agency
(If
Applicable)
Position for
Which
Filing
C a n ~ j 9 i : i t 1 3 f o r
President
klN/A
Auuress
(Number.
Street.
City,
State, and
ZIP Code)
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~
Telephone
No.
(Include Area
Code)
Present
Office
Location
of
585
C:OmlTlercial.
Street; Eloston,MA02109
· · 1 8 5 7 ~ 2 8 8 - 3 5 0 0
(or forwarding address). Title of
Position(s)
and Date(s)Held
Posltlon(s) Held with the FederalGovernment During the Preceding
N/A
12
Months
(If
Not Same as Above)
,
Name at congressional committee Considering
Nomination
In"
Vn11
Tntpnn tn
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':
f'l1l':lHf;,on
ni"":>reifi",,ri
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Presidential
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Senate Confirmation
INofAPplicable·
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Yes
UNo
Certification
[CERTIFY
that the statements I havemade on this form and allattachedschedulesare true, completeand correct
•••
C
••••••
myknowledge.
Other
Review(If
desired
byagency)
Signature
of
Reporting
I n d i v i ~
Date
(Month,
Day, Year)
A-/7/L
June
1,
2012
Signature
of
Other
Reviewer
/
Date
(Month,
Day, Year)
/
AgencyEthics Official's Opinion
I
Signature
of
Designated
Agency Ethics Official/Reviewing OfficialDate
(Month
Day, Year)
Signature
Offlce of
Government
EthiCSI
I
Date
(Month, Day, Year)
I
~ _ .
, •
~
~ .
-•
.,,_
...
----_._"
I
Arrangernentsj-onow any agreements
orUse
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arrangements
as
of the date
of filing.SCh e d u 1e D
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reporting period
is
Comments
of Reviewing Officials
(ff
additional
space is
required,
use the
reverse
side
of
this
sheet)
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the
preceding
two
calendaryearsand
I
the current calendar year
up
to
the date
-1
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Report
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,chidl8afsHm'le
W. Mitt
Romney
[W.MIt& Ann
Romney]
SCHEDULE
A
Page
Number
1
of
12
Assets
and
Inconli!
valuationof
Assets
at dose
of
reportins
period
IncomeTypeand
AmoIRlt.
If"None (or lessthan $201)"15
checked,
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if
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Mitt Romney
IW.
MfttRannev
Mnd
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SCHEDULE
A
Page
Number
2
of
12
AssetsandIncome
ValuatiOn
of
Assetsat dose of reporting periodIncomeTypeand Amount.
If
"None(or essthan $201)" s
checked,
noother
entry
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n blockCfor that
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