You are on page 1of 15

FOR CALENDAR YEAR 2009

1. Pcz~on Rcportin[ (~azt name, fir~ middle i~J~]) DLOTr, SUSAN L


4. Title (A~clc I~ judges indicatc active or s~mior stat~; magix~tcjudgcs indicat~ full- or pad-time)

in Government Act of1978

(5 vs.c ,v,],. ~ 707-~10


3. Date o[ Report 4/14/2010
6. Rcport~ag Period 01/01/2009 IZ~B1!2009

2. Court or Organization US SOUTH~IL~ DISTRICT OF OHiO


5~. R~por~ Type (c.h~ck apiuopriatc type) [] NomLu~a, D~,

US COURT HOUSE 2ND FLOOR ROOM 227 C]~CIN~ATI OHIO 45202

modific~tior~s pertaining tbcx~o, it J~, in my opinion~ in omplitlc with applicable Laws snd regulations. Reviewing OWw.e r D ate

IMPORTANT NOTES: T~e i~utruct~r~ accomj,~,in~ this form mu~t be fdlm~e,! Complete all part~
che~king the NONE box for each part where you hm,e no reportable information, Sign on last pag~

NONE (No reportable positions.) POSITION NAME OF ORGANIZATION/ENTITY


, : :~ ] ESTATE

1.

CO-PEtLSONAL REPRESENTATIVE

[~

NONE (No reporlable agreements.)

DATE
i.

PARTIES AND TERMS

Dlott, Susan J.

FINANCIAL DISCLOSURE REPORT Page 2 of 15

l~LOrr, svsAr~ at.

4/t4t2o~o

HI. NON-INVESTMENT INCOME. ~,,g A. FHers Non-Investment Income


NONE (No repgrtable non-investment income.)

DATE
I.
2.

SOURCE AND TYPE

INCOME
(youa-~, not spouses)

3.
4.

B. Spouses Non-lnvestment Income - lf yow tt~r married during any p~raon of th rtpor~g y~ar, c~l~e ~ ~
~I~ om~ ~t ~red ~ for ~)

NO~ ~o r~ortable non-investment income.) ~ SO~CE AND ~E


PI~ ~ a~ I~ ~ ~ on F~ciM ~1~.

1. 2. 3.

4.

(l~ude~ au~e ~ xpo~e and ~d~m chitdrm: s~ pp. 25-27 of filing inarucaons.)

[~]

NONE (No reportable reimbursements.) SOURCE DATE~ LOCATION PURPOSE ITEMS PAID OR PROVIDED

I. 2. 3. 4. 5.

FINANCIAL DISCLOSURE REPORT Page 3 of 15

Name of Person Reporting:

Date of Report

I OLO ,SUS.
DES~ION

V. GIFTS. a,,~,~,~ ~hose lo n, o~e ,~t ~t,~,~,,a~ ct,~o,; ,,,~ r~ z~-J l NO~ ~o rego~able ~
1,

3.

5.

CRgDtT~R
I. 2. 3. 4.

DESCRI~N

V~ CODE

FINANCIAL DISCLOSURE REPORT Page 4 of 1 5

~,,,ofP ....R.pom.g DLOTT. SUSAN J.

D.t,,fa,~n 4114n0~0

I. 2. 3. 4. 5. 6. 7. 8, 9. 10. 11. 12.

BOND-GREEN OI~O INCOME TAX RE~ COMM, LEARNING CENTER BONI~-AKRON OHIO SEWER SYS REV SERIES 1998 4.6@/, DUEI2/I~9 BOND-BLLrE ASH OH SERV GARAGE & FIREHOUSE 3% DUE ] 111110 BOND-CINCI2ffNATI OHIO CITY SCHL FAC CONS & IMPR 5%DUEI2/I/09 BOND-FRANKLIN CO,OH HOSP REV HOLY CROSS 5% DUE 611109 BOND - CINCINNATI OHIO CITY SCHOOL DISTRICT 5/, DUE 12/1/15 BOND. FAIRFIELD & UNION LOCAL SCHOOL, 3,875%, DUE 12/1112 CASH held in custodian at Johnson [nvrnstmmts (#9~) CASH held in custodian ~ Johnson Invcstrmrnts (#8932) Womrns capital club partnr~hip (2.5% onwrr~ip)) ILLnqOIS EDUC FAC AUTH R MORRIS COLLEGE 5% DUE 6/1/09 BOND-LORAIN CO OH REV CATH HEALTHCARE 5.2% DUE 911110

D C C D C D D

Int~r~ Infarct lntmrst Int.~mst Intrust lntrre.st In~rst None None

T Matured 12/01/09 L A

T Matured Maturrd 12]01109 06/01/09 M M A A

M M N J K

T T T T W Matu~xi 0~/01109 M A

A C D

Distribution Intrust Int~st Interest

M I

T T Sold Sold 02/13109 L 02/04/09 K E A

! 3. FfFTH TH]RD BANK CHFJZKING ACCT~ A 14. 15. SHS SYSCO CORP SHS ADOBE SYSTEMS INC A

Di~ddcnd None

16. 17.

BOND-LAKE OH LOCAL SCH DIST GEN OBLIG 5.35% DUE 12/01/11 SHS AKAMAI TECHNOLOGIES

Int~r~t None

T Sold 02/12/09 K A

Name of Person Reporting

Datc of Report

PagcF[NANCIAL5 of 15 DISCLOS~ ~PORT

DLO~, SUS~

J.

~14~01 0

NO~ ~o r~ortable income, ~sets, or ff~actio~.)


A. D~ of~s~ B. ~ d~g O) (2) C. ~ v~u~ ~t ~ 0) (2) 0) D. T~o~ (2) O) (~)

18. 19. 20. 21. 22. 23. 24. 25. 26. 27.

SHS D~ CO~ON SHS C~IEVRON CORP SHS EXXON MOBIL (~932) SHS ISHARES S&P SMALLCAP 600 SHS Iv[ICROSOFT CORP SHS PEPSICO INC SHS .IOH]qSON FIXED INCOME FUND SHS BI~a BILLITON LTD ADR SHS CONOCOPHILLIPS BOND-CLEVELAND OH WATERWORKS REV I STMORT SERIES G 5.5"/~ 2013 SHS CATERPILLAR TRACTOR SHS DANAtIT:,K CORP (#8932) Fifth Third Bank St~ck SHS PROCTER & GAMBLE CO SHS CISCO SYSTEMS INC SHARES WELLPOiNT INC

A A A A B C E A C D

~d l~vid~d Divld~nd Divid~ad Dividemd Divided Divided Dividend Dividend Intvm;t M L N 1 L M T T T T T T J T

Sold Sold Sold Sold

0~1~ ~ 08/27/09 08/27/09 02/03/09 L

Buy

07/29109

28. 29. 30. 31. 32. 33. 34.

A A A D

Dividend DivlcLmd Di.vid~nd Divicknd None None Divi&md J T M I T T

Sold Sold Sold

1.0/01109 10/19/09 08113109

I J K

A A A

Sold Sold

02/13/09 02/04/09

L L

D E

SHARES EQUITABLE RESOURCES INC A

FINANCIALDISCLOSUREREPORT
Page 6 of 15

Name of Person Rep~rtin~

Dale of Report

4n4aoto

VII. INVESTMENTS and TRU ST S - ~=o,.~ ,.~,,,. ~,~,,~ a.dud~ ,h~,e of.r.,.*e ~,d d~.,d~.t rh#~ .~ r~ 3*-60
NONE (No reportable income, assets, or transactiors.)
A. D~cfip~on of Arae~ (iadudi~g tst ram) Place "CA)" aRrr tar.h asset except fiom pri~" disclosur~ B. In~:n during repo,~g lmiOd CD Amount Code 1 (A-H) (2) Type (e.g., div., rent, or int.) C. C, mss v~flue at end ofrtporti~Ix~od ~2) O) Value Value Mrthod Code 2 Code 3 (I-P) (~w) K L T T D. Tr~acfions d~ring mportiug period O) Type (~g., buy, sell, rcdcmption) (~) O) (4) Dat~ Value O~in mm/dd~y Code 2 Code I (J-P) (A-H)

Identity of buy~r/sdler (if privst e

35. 36. 37.

SHARE~ GENERAL ELECTRIC COMPAre SIIS EXXON MOBIL CORPORATION SHARF~ ROYAL DUTCH PETROLEUM

C C A

I)ividend Dividend Dividend

Sold (part) Sold Sold

10/01/09 02/04109 02/13/09

COMPANY (NETHEeJ.ANDS)
SHS IOHNSON & JOHNSON
SHARES NOVARTIS AG ADR

38.

C
A D D D C D C A A C D

Divid,nd
Dividend rmtemst Intcrr.st Interest Intta-rst Intcrrst Interest Dividend Dividtmd Int~rcst Int~-cst Interest

M
K M M M M M M

T
T T T T T T T Sold Sold 03106109 J 10/19/09, K B A

39.40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51.

LAKE3VOOD OHIO GEN 5.0% DUE 12/1114 DATED 5~26105 GAHANNA OHIO GEN 5.0% DUE 12/1/18 DATED 911105 IACKSON OHIO LOCAL SCItOOL DIST 5.0% DUE 12/1/16 DATED 4/2110 ~OR OHIO GEN 5.0% DUE 12/1/15 DATED I0/!/05 UNION COUNTY OHIO 4.5% DUE 12/1/14 DATED 7/1/05 UNIVERSITY OF CINCINNATI GEN 4.0% DUE 6/1112 DATED 311105 OCCIDENTAL PETROLEUM CORPORATION STR.YKER CORPORATION BOND - OHIO HOUSING FINANCY AGENCY MORT REW,3.95%,DUE 911115 OI~O STATE DEPT OF ADMIN SERVICF~ COP, 5%, DUE 911/11

M M L M

T T T T

PICKERINTONOHIO LOCAL SCHOOL, C 4.125%, DUE 12/1/16 STATE OF OHIO INFRASTRUCTURE IMP, 4%, DUE 2/1/13 C

Intr~cst

57. 58. 59. 60. 61. 62. 63.

EMERSON ELECTRIC COMPANY THOR.NBURG INTERNATIONAL VALUe FUNV COMCAST CORP CLASS A SPECIAL GILEAD SCIENCES I~C ROCH~E IIOLDDqGS LIMITED - ADR UNITED HEALTHCARE CORP SHS KELLOGG COMPANY

B B A

Dividend Dividvnd Dividend None

L L J

T T T Sold 10/19/09 J B Sold (p~) 02J04/09 L A

A A A

Dividend Dividvad Dividend

T Sold 10/01/09 J A

64.
65. 66. 67. 68.

SHS KRAFT FOODS [NC


BOND - STATE OF OIl~O BLDG ALrIH REV,5%, DUE 10]1/17 SHS US BANCORP OH]O MUNI ELECTRIC GENERATION AGENCY" REV CALLABLE 2-15-14 BECTON, DICKD4SON AND COMPANY

A
D A D A

Dividend
Latcre~t Dividend Intcn~ Dividend M J M l T T T T

Sold

06/30109

FINANCIAL DISCLOSURE REPORT Page 8 of 15

~ .... tr~n R~po~g VLOTr, SUSA~ J.

v,t, of~t 4/14r2010

74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85.

PRINCIPAL FINANCIAL GROUP SAFEWAY INCORPORATED GOLDMAN SACHS GROUP INC GS FTNL SQ MMKT INSTL INTUITIVE SURGICAL INC MANITOWOC COMPANY INC MINDRAY MEDICAL INTL LTD PEPSICO INCORPORATED PETROLEO BRASILEIRO - SA POLO RALPIt LAUREN CORP TATA MOTORS LTD - SPNS ADR GREATER CLEVELAND OIIIO REGIONAL TRANSPORTATION AI.~ORITY GNE A A A A A A D B A A

None Dividend Dividend Dividend None Dividend Dividend Dividend Dividend Dividvod Dividend Intt:a~t J J J K K K M T T T T T T T L K T T

Sold Buy

10/19/09 02/04/09

J L

Sold Sold

03105109 06/11109

L K

A A

Sold

10/19109

Page 9 of 15

4/14~010

NO~ ~o reportable income, ~sets, or ~a~actio~.)


~ D~ of~ B. In~c d~g C. Gr~s v~u~ st ~d D. T~ d~g ~ng ~

(A-H)

~ i~)

(I-P)

C~= 3

~)

(I-P)

(A-~

(if

86. 87. 88. 89.

MASON O~O GEN 4%D~ I~021~0 NORTH OLMSTED OHIO GEN. 5.2.50% DUE ! 2/1/20 OHIO STATE HOUSING FI]~ANCE AGENCY REV 3.7% DUE 12/!116 BANK. OF NEW YORK MELLON CORP

D D C A

~t Intexest Interest Dividend

M M L

T T T Sold 10/01/09 L A

90. 91. 92.


93. 94. 95. 96. 97. 98.

FPL GROUP INC JOHNSON DISCIPLINED MID-CAP FUND VANGUARD MONEY MARKET
Beavcrcr~ek Ohio city school district 4.75% DUBLl~ OHIO CITY SCHOOL DISTRICT FAC. 4.0% KENTON CTY. KY SCHOOL D1STRICF FINANCE 4.5% KENTUCKY STATE PROP AND BLDG. COMMISSION 5,0% RISING SUN ]]q. SCHOOL BLDG. CORP. 3.8% WALGREEN COMPA_NY

Dividend None

T Sold 02/03/09 : 12/02/09


06/12/09 02/18/09 02/17/09 10/28/09 12/16/09 10119/09 02/03/09 01106109 12/23/09

M N
M M M M M K K K K

D
C D C

Dividemd
Imgrest Interest Intert~t None

O
M M M M M L

T
T T T T T T

Buy
Buy Buy Buy Buy Buy Sotd Sold Buy Sold

C A A

Interest Dividend Dividend None None

E A

99. XTO Energ~t 100. GAMESTOP CORPORATION 101. G~OP CORPORATION

102. TYCO INTERNATIONAL LTD

Dismbution

FINANCIALDISCLOS~ ~PORT Page 10 of 15

Name of Persom Rcportinl~

Date of Report

4/140010

NO~ ~o r~r~ble income, ~se~, or ~ac~o~.)


A. D~ of~ B. ln~e d~g C. ~o~ v~ue at ~d D. T~a~o~ d~g ~g ~M

(A-~

a ~t)

(J-P)

~3 (~

~)

(l-V)

(if~ ~)

103. ~ ~~ CO~ 104. ALLSTATE CORPORATION

B A

Di~on Dividend Sold 10/01/09 I A

105. APPLIED MATERIALS, INC


106. NORFOLK SOUTHERN CORPORATION 107. POTASH CORPORATION OF SASKATCHEWAN, lNC 108. BOEI!qG COMPANY 109. TARGET CORPORATION

A
A A A A

Divided
Dividend Dividend Dividend Dividend

I
J J

T
T T

Buy
Buy Buy Sold ,Sold

07/01/09
06/30/09 06/30/09 06/17109 !04/20109

J
J J J J A A

110. FREEPORT MCMORAN COPPER & GOLD 111. FREEPORT MCMORAN COPPER & GOLD 112. AMERICAlq INTERNATIONAL GROUP, INC. ! 13. JOI-INSON FIXED INCOME FUND
114. FIRST AMEKICAN TREASURY OBLIGATIONS FUND 115. ~RICAN EXPRESS

None None A C
A A

Buy Sold

01/06/09 08/27/09

J l D

Distribution Dividend
Interest Dividend

J
J

T
T

Buy
Buy Sold

07/29109
07/29/09 06/11/09

J
J K D

116. ARCHER DANIELS MIDLAND 117. BP PLC SPONS ADR


118. DPL INC

A A
A

Dividend Dividend
Dividend

K J
K

T T
T Buy 03/05109 K

i 19. EVERGREEN MONEY MARKET

Dividend

Sold

12/01/09

DISCLOSURE REPORT Page 11 of 15

Name of Person Repor/ing

Date af

4/14ao~o

I ~LO~r, SUSA~ J. VII. INVESTMENT S an d TRUST S - ~,~o,~ ~a,o. ~,~, a~a.,~,, thoso o/ ,po=o .,a do~,~,~,t ,hua,,~; .~, ~ ~.o o/ra~# ~
NO~ ~o repo~able income, ~sets, or ~actio~.)
D~p~ of~ (racing ~ ~) PI~ "~" ~ ~ ~ ~pt ~ p~ ~cl~ h~e d~ng r~g p~ 0) (~) T~ (e.g., ~ C~e 1 ~v., ~ (~-~ ~ ~) ~ss ~ue at ~ of~g ~ (D Value ~e 2 (J-O) (Z) V~ue M~ ~3 (~ 0) T~ (e.g~ b~, soil ~:~) T~a~o~ dmng r~ng ~ (~) Dam ~d~ O) (4) Value G~ C~e 2 ~e I (J-e) (~-~ (5) Id~ of b~/sell~ (if~

120. GS F~ SQ ~T ~S~

None

~y

01/0~ L

121. ~PLE ~C

None

B~

06/i l/~

I~. ~CS L~

None

1~. ~BRO ~C

~d~d

Buy

01/15/09

124. ~U~ SE~OR SPDR 25. ~g MSCI ~ ~

~d

~d~d

126. ISiS ~MS~ ~RG~G

Di~d~d

127. ~OG~ COMP~ ~ON

~d~d

B~

03/05/09

128. ~D~O~C ~C

~d

129. ~SE ~O~

~d

B~

01/15/09

130. P~ ~SS ~C

~d~d

131. S~ERGER L~

~d~d

132. ~R~OLIO ~CO~RY ~S~

None

133. S~COR ~RGY ~C

~d

1M. ~

~d

Sold

~/l 1/~

135. HOL~IC

None

~Id

~/ll~

136. AT&T ~C.

None

Buy

11/05/~

137. FEDERATED MU-N!CIPAL CASHTRUS] C 138. WELLS FAR.GO MONEY MARKET


139. VANGUARD SHORT TERM I~IVF_.STMEN~ GRADE FUND 140.

lnlxa-~ Dividend
Dividend

Sold J
N

12/31/09 J 6/30109
7/29109 N

A
A

T
T

BUY
Buy

141. 142.

~I~ I)ISCLOSUR~ REPORT Page 13 of 15

DLo~r,Name of PersonJ. S~S~ Repor{lng

Da|e Df l~el~r~

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS.


PART VII LISTED STOCKS ARE COMMON SHARES UNLESS OTIi~RWISE NOTED. ALL WOMENS CLUB INVESIMENTS ARE REPORTED AT THE AGGREGATE VALUE. JUDGE DLOTT OWNS LINES 8 AND 9 ARE CASH ACCOUNTS HELD IN INVESTMENT ACCOUNTS FOR FUTURE PURCHASES. LINES 102,103, AND 112 ARE DISTRIBUTIONS OF SECURITIES LITIGATION SETTLEMENTS FROM INVESTMENTS HELD PRIOR TO THIS "YEAR LINE 109 TARGET WAS SOLD IN THE CURRENT YEAR IN Fh4TIRE-FY AND WAS INLCUDED ON LINE 19 IN THE PRIOR YEAR LINE 135 StIARES OF HOLOGICS ARE THE TOTAL COMBINED FROM THE PRIOR YEAR LINES 56 AND 124 AND ! 92 LINE 91 JOHNSON MIDCAP WAS COMBINED DUE TO SALE IN ~ CURRENT YEAR AND WAS SHOWN ON LINES 60 & 182 IN THE PRIOI~ LINE 128 1MEDTRONICS WAS SHOWN ON LINE 71 IN PRIOR YEAR- MOVED FOR EASIER DISPLAY LINE 99 XTO ENERGY WAS ON I!hiE 84 MOVED IN GROUPING FOK EASE OF ENTRY LINE 104 ALLSTSIE CORPORATION WAS SHOWN ON LINE 85 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPOR.TING LINE 122 AMDOCS WAS SHOWN ON LINE 120 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 133 SUNCOR. WAS SHOWN ON LINE 121 llq PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 117 BP PLC ADS WAS SHOWN ON LINE 122 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 130 PET MED EXPRESS WAS SHOWN ON LINE 126 IN PRIOR YEAR MOVED IN GROUPING FOR. EASE OF REPOR.ING LINE 114 FIRST A~CAN TREASURY OBLIGATION FUNDS WAS SHOWN ON LINE 128 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPOR.TIING LINE I 15 AMERICAN EXPRESS CREDIT CORP WAS SHOWN ON LINE 130 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING SALE LINE 131 SCItLUMBERGER WAS SHOWN ON LINE 131 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 134 ISIIARES WYETH WAS SHOWN ON LINE 132 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 125 ISILARES MSCI EAFE ]INDEX WAS SHOWN ON LINE 133 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 126 ISHARES TR NISCI EMERGING MARKET WAS SHOWN ON LI]E 136 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 132 POR.TFOLIO RECOVER. ASSOCIATES WAS SHOWN ON LI]qE 138 IN PRIOR YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 121 APPLE INC WAS SHOWN ON LllqE 143 IN PRIOR YEAR MOVED IN GROUPING FOP. EASE OF REPORTING LINE 76 GOLDMAN SACHS IS THE TOTAL COMBI!,/ED FROM TIIE PRIOK YEAR LINES 145 AND 162 LINE 19 CHEVRON CORP IS TIlE TOTAL COMBINED FROM THE PRIOR. YEAR LINES 153 AND 31 I.!NE 78 INTUITIVE SURGICAL IS THE TOTAL COMBINED FROM THE PRIOR. YEAR LINES 165 AND 166 LAST YEAR COACtt [NC LINES 190 AND 106 AMOUNTS - THE SALE WAS REPORTED ON UNE 106 FOR BOTH LOTS THEREFORE COACH WAS REMOVED FROM TIlE SCIIEDULE LINE 108 BOEI]qG INC WAS SHOWN ON LINE 193 IN PRIOP. YEAR MOVED IN GROUPING FOR EASE OF REPOP.TING LINE 99 XTO ENERGY WAS SHOWN ON L12NE 84 IN PRIOR. YEAR MOVED IN GROUPING FOR EASE OF REPOR.TI~IG LINE 32 CISCO SYSTEMS IS THE TOTAL COMBINED FROM THE PRIOR. YEAR LINF~ 73 AND 59 LINE 98 WALGREENS WAS SHOWN ON Ll]qE 40 IN PRIOR.YEAR MOVED IN GROUPING FOR EASE OF REPORTING LINE 100 & 10! GAMESTOP WAS BOUGtIT AND SOLD IN ONE YEAR AND THERE WAS NO ROOM TO REPORT THE BUY AND SELL ON ONE LINE LINE I I 0 & 111 FREEPORT MCMORAN COPPER AND GOLD WAS BOUGHT AND SOLD IN ONE YEAR AND THERE WAS NO ROOM TO REPORT THE BLry" AND SELL ON ONE LINE

FINANCIAL DISCLOSURE REPORT Page 14 of I5

] ~,=~ of e~o. a~-i~,t I DLOTT, SUSAN J,

~.or.~ 4II4/2010

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS. ana~a, moI~nJ


PART I POSITIONS JUDGE DLOTr SERVES AS CO REPRESENTATIVE OF [ ESTATE - SHE HAS NO INTFAhEST IN TH~ TRUST AND DOE NOT MANAGE OR CONTROL TH~ ASSETS OF THE TRUST -SO THERE IS NOTHING REPORTED ON INVESTMENT TAB IN ACCORDANCE WITH DIRECTION FROM PRIOR YEAR

FINANCIAL DISCLOSURE REPORT I ~ .... ~ P.r,on ..po~n~ Page 15 of 1 5 IX. CERTIFICATION.


DLOTT, SUSAN J.

~.,. of Re~. 4114/2010

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-~isclosure. 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. app. 501 eL seq., 5 U.S.C. 7353, and Judicial Conference regulatinnso

Signatu~

NOTE.: ANY INDIVIDUAL WIlO KNOWINGLY AND W1LFULLY FALSIFIES OR FAILS TO FILE THIS REPORT MAY BE SUBJECT TO CML AND CRIMINAL SANCTIONS (5 U.S.C. app. 104)

FILING INSTRUCTIONS Mail signed original and 3 additional copies to: Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544

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