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FINANCIAL DISCLOSURE REPORT
FOR CALENDAR YEAR 2009
2. Court or Organization U.S. District Court, Ohio 5a. Report Type (check appropriate b’pe) [] Nomination, [] Initial Date [] Annual [] Final

Rcpo,t Requiredby the E.thics
in Government Act of 1978

:5 u.s.c, o/,p. L¢ IOt-/lO
3. Date of Report 05/15/2010 6. Reporting Period 01/01/2009 to 12/31/2009

I. Person Reporting (last name. first, middle initial) Black, Timothy S. 4. Title (Article Ill judges indicate active or senior shatus; rmgistratejudges indicate full- or pard-time) U.S.Magistrate Judge fulltime

7, Chambers or Office Address 7] 6 United States Courthouse 100 East Fifth Streel Cincinnati, OH 45202

5b. [] Amended Report 8. On lhe basis of the infomalloa contained in this Report and any modll’~cattons pertaining thereto, It h, In my opinion, In compliance with applicable laws and regulations. Reviewing Officer Dale

IMPORTANT NOTES: The instructions accompanying this form must be followeg Complete all parts, checking the NONE box for each part where you have no reportable informatio~ Sign on iast page.

I. POSITIONS. ~ero,,,g ~a~u.a o.t),: ,ee r,. +-~J o/fa~.s instructions.)
NONE (No reportable positions.) POSITION
I. 2.

NAME OF ORGANIZATION/ENTITY

~

NONE (No reportable agreements,) ~ PARSES A~ TERMS

].

Black, Timothy S.

FINANCIAL DISCLOSURE REPORT Page 2 of 6

N.=, alp .... Re~o~,g mac~, Timolhy S. ]

D.t, or Repo, 05/15t2010

II1. NON-INVESTMENT INCOME. tRo.o.ing in~i~idu.: .~ ,~, ....
A. Filer’s Non-lnvestment Income NONE (No reportable non-investment income.) DATE
I.

~ .oo r~,. 17-2~ o[l’.ti,~ i~s,...ion.~

SOURCE AND TYPE

INCOME
(yours, not spouse’s)

B. Spouse’s Non-Investment Income - lf ro. ~tre married during °nF portion of the reponing j,ear, complete this sectior~
(Dollar amount not required except for honoraria.) ---] NONE (No reportable non-investment income.) DATE I. 2009

SOURCE AND TYPE
self-employed, part-time tutor; part-time employee, Mane°verdi Residence Club

IV. REIMBURSEMENTS -,run,~,.otio.. I,~,g.~ooa..~o~.~,.(Include~ those to spouse anddependent children; ~ee pp. 25-27 of filing instructions.)

[~

NONE (No reportable reimbursements.) SOURCE DATES
Febrtmry 19-21, 2009

LOCATION
Lexington, KY

PURPQSE
legal education

ITEMS PAID OR PROVIDED
food and lodging

I.

Cincinnati Bar Association, 225 E. Fifth St., Cincinnati, O11 45202 The Justice Institute for the Legal Profession, 201 E. 5th St., Cincinnati, OH 45202

2.

July 19-26, 2009

Tuscany, Italy

legal education

transportalion, food & lodging

FINANCIAL DISCLOSURE REPORT Page 3 of 6

Black, T|mothy S.

05115/2010

V. GIFTS. ana,~,, ,h,~, ,o ,, ...... ~ dependent children; ,et pp. 28-31 of fding i~tructlon~)
NONE (No reportable g~s.) ~
1. 2. 3. 4. 5.

DESCRIPTION

~

NONE (No reportable liabifities.) ~ DESCRIPTION
~edit ~ne student loan~ ................

1. 2.

~eybank US Dept. of Education- Win. D. Ford Fede~l Di~t ~an Prog~m Ameri~n Express

I

3. 4. 5.

credit ~d

FINANCIAL DISCLOSURE REPORT

s .... fPerson Reportlag Black, Timothy S.

Date of Repor~ 05/15/2010

Page 4 of 6
VII. INVESTMENTS and TRUSTS - in~o.e, ~*t.e,

~

N ONE (No reportable income, assets, or tra.sactions.)

.......... ~. - ....................
Desc~ption of As~ts (including ~s~ assets) Place "~)" after ~ch ~ exempt from prior di~losure .................. I, 2. 3. 4. 5, Fifth Third Bank ac~unts Fifth Third Bank (IRA - cash) Vanguard Windsor Fund (IRA) TIAA-CREF ~’IAA -CREF

~ ........
; In.me during [ reporting period [ (I) (2) ]Amount T~¢ (e.g., div., rent, ~ Co~ 1 (A-H) ~ or int.) L i A interest none none none none

~ ....................
Gross value a~ ~d orating period (I) (2) Value Value C~e 2 Me~od (~-P) Co~ 3 (~W) J K K L L T T T T T

~. " ...............
Tran~ctions during re~ning ~fiod (5~ ....... Identity of buy~/~Her Iran~ction) I

"-- (1~--" (2) ~ 3) [ {4) ...... T~ (c.~., Date[ Va~e Gain buy, sell mm/d~ Cod~ 2 ~dc I ~emption) ~ [

ii0, 11. 12.

13.
14. 15. 16. 17.

2. Val~ C~cs (~ Columns CI ~ D3) 3, Vai~ ~hod C~s

J =$15.0~ o~ l~s N =$250.~1 - $5~.0~ Q ~Apprai~al

K =$15.~1 - 15~.~ O -$5~.001 - $ I.~.~ R ~ost ~Rcal ~a~ ~ly)

L =$50,001 - $1~.0~ PI -$1.~,~1 - $5.0~,~ S "Ass~ssme~

M =$100.~1 - $~0.~ ~ =$5.~.~1 - S25,~.~ T ~ash

FINANCIAL DISCLOSURE REPORT Page 5 of 6

s ....f P ..... R,po~tlng mack, Timothy S.

05/I 5/201

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS.

FINANCIAL DISCLOSURE REPORT Page 6 of 6 IX. CERTIFICATION.

r~ ....t ~’,rson ~o.~g mack, Timothy S.

o.,, o~ a~ 05115/2010

1 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 ef my knowledge 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 g|fts 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.

Signaturet" NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES OR FALLS TO FILE TItlS REPORT MAY BE SUBJECT TO CIVIL 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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