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Debevoise_Dickinson_R
SOURCE INCOME
PROVIDED
FINANCIAL DISCLOSURE REPORT
Page 2of12
Name of Person Reporting
Debevoise, Dickinson R.
Date of Report
04/02/2009
III. N 0 N-INVES TMENT INC 0 ME. (Reporting individual and spouse; see pp. 17-24 of filing instructions.)
A. Filer's Non-Investment Income
D NONE (No reportable non-investment income.)
I. 6/01/08
2.
3.
4.
AND TYPE
Marsh (Class Action) Settlement Fund
(yours, not spouse's)
$16.55
B. Spouse's Non-Investment Income - lf you were married during any portion of the reporting year, complete this section.
(Dollar amount not required except for honoraria.)
!ZJ NONE (No reportable non-investment income.)
SOURCE AND TYPE
I.
2.
3.
4.
IV. REIMBURSEMENTS transportation, lodging.food, entertainment -
(Includes those to spouse and dependent children; see pp. 25-27 of filing instructions.)
[Z] NONE (No reportable reimbursements.)
SOURCE DATES LOCATION PURPOSE ITEMS PAID OR
I.
2.
3.
5.
2.
Name of Person Reporting
Debevoise, Dickinson R.
Date of Report
04/02/2009
FINANCIAL DISCLOSURE REPORT
Page 3of12
V. GIFTS, (Includes those to spouse and dependent children; see pp. 28-31 of filing instructions.)
D NONE (No reportable gifts.)
SOURCE DESCRIPTION
l. District Court Lawyers' Advisory Com mittee
2.
3.
Dinghy and Boat Equipment
VALUE
$1,700.00
VJ, LJABJLJTJES. (Includes those of spouse and dependent children; see pp. 32-33 of filing instructions.)
[Z] NONE (No reportable liabilities.)
CREDITOR DESCRIPTION
I.
VALUE CODE
3.
4.
5.
Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT
Page 4of12 Debevoise, Dickinson R. 04/02/2009
VII. INVESTMENTS and TRUSTS income, vatue, transactions (Includes those of spouse and dependent children; see PP· J4-6o of filing instrucnons.J -
D NONE (No reportable income, assets, or transactions.)
A. B. c. D.
Desaiption of Assets Income during Gross value at end of Transactions during reporting period
(including trust assets) reporting period reporting period
(I) (2) (I) (2) (I) (2 ) (3) (4) (5) Place "(X)" after each asset Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of
exempt from prior disclosure Code I div., rent, Code2 Method buy, sell, Month - Code2 Code I buyer/seller (A-H) or int.) (J-P) Code3 redemption) Day (J-P) (A-H) (if private
(Q-W) transaction)
I. UBS Financial Services Cash Fund, Iselin, B Interest L T NJ
2. UBS Financial Services Cash Fund, Iselin, A Interest J T NJ
3. PNC Bank, N.A., Millburn, NJ A Interest K T
4. Wachovia Bank, Millburn, NJ None J T
5. Wachovia Bank, Newark, NJ None J T
6. Nuveen Bond Fund, Unit 519 - A Interest J T See PartVIII
7. Nuveen Bond Fund, Unit 522 - A Interest Matured 1115 J A
8. Williams College Pooled Income Fund #3 c Interest L T See PartVIII
9. Wachovia Bank, Millburn, NJ None J T
10. - N.J. State Due 8/1/20 B Interest K T See VIII
11. - So. Jersey Transit Auth. 11101118 B Interest K T See VIII
12. -N.J. Health Care Auth. 07/01/20 B Interest K T See VIII
13. - Monmouth Cty. Imp. Auth. 12/01/ B Interest K T See VIII 16
14. -N.J. Health Care Auth. 07/01/12 B Interest K T See VIII
15. - Lopatcong Twp. 7/15/22 B Interest K T Sold 519 K A See VIII (part)
16. Winslow Twp. Bd. ofEd. 8/01/19 B Interest K T
17. Bank of America Brunswick, ME A Interest J T
I. Income Gain Codes: A =S 1,000 orless B =S1,00 I - $2,500 C =$2,50 I -$5,000 D=S5,00l -Sl5,000 E =Sl5,001 - $50.000 (See Columns BI and D4) F =$50,00 I -SI 00,000 G =$I 00,00 I -S 1,000,000 HI =Sl,000,00I -S5,000.000 H2 =More than $5,000,000
2. Value Codes J =$15,000 or less K =$15,001- $50,000 L =$50,001 - SI 00,000 M =SI 00,00 I - $250,000 (See Columns Cl and 03) N =$250,001 -$500,000 O =$500,001 - Sl,000,000 Pl =$1,000,001 -$5,000,000 P2 =$5,0oo,001 -$25,000,000
P3 =$25,000,001 - $50,000,000 P4 =More than $50,000,000 3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Asse5$ment T =Cash Market
(Sec Column C2) U =Book Value V=Other W =Estimated
J
c
25.
31.
34.
Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT
Page 5of12 Debevoise, Dickinson R. 04/02/2009
VII. INVESTMENTS and TRUSTS income, value, transactions (Includes those of spouse and dependent children; see PP· 14-60 of filing instructions.) -
D NONE (No reportable income, assets, or transactions.)
18.
A.
Description of Assets
(including trust assets)
Place "(X)" after each asset
exempt from prior disclosure
-Trust See VIII
B. c. D.
Income during Gross value at end of Transactions during reporting period
reporting period reporting period
(I) (2) (I) (2) (!) (2) (3) (4) (5) Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of Code I div., rent, Code 2 Method buy, sell, Month- Code 2 Code I buyer/seller (A-H) or int) (J-P) Code 3 redemption) Day (J-P) (A-H) (if private
(Q-W) transaction)
E Dividend Pl T
19. -Trust See VIII E Interest P l T
20. -Blackrock NJ. Munic. (BN} Bonds Fund
-
21. -BP PLC
22. -Bristol Myers Squibb Com.
23.
24.
-FPL Group, Inc. Com.
-Chevron Texaco Corp. Com.
Sold (part)
Sold (part)
2/11
6/11
J
J
D
D
26.
-International Paper Com.
-Peapack Gladstone Finan_cial Corp. Sold 2111 D
27. -Unilever NU New York Com.
28. -Roxiticus Golf Club Com.
29.
30.
-Kimberly-Clark Com.
-Blackrock Liquidity Funds
Sold (part)
2111 J B
See VIII
32.
-Hammonton 4.75% due on 7/1/18
- Margate City 4.75% due on 211/17
33. -Cape May Co. N.J. College due 8/15/16
-General Dynamics Com. Sold 3/31 J (part)
1. Income Gain Codes: A =Sl,000 or less B=S 1,00 I - $2,500 c =$2,501 -$5,000 D =$5,001 -$15,000 E =$15.001 - $50,000 (See Columns BI aod 04) F=$50,001 - $100,000 G=SI00,001-$1,000,000 HI =$1,000,001- $5,000,000 112 =More than $5,000,000
2. Value Codes I =$15,000 or less K=$15,001 -$50,000 L=S50,001-$100,000 M=SI00,001-$250,000
(See Columns Cl and D3) N=$250,001 -$500,000 0=$500,001 -$1,000,000 Pl =$1,000,001 -$5,000,000 P2 =$5,000,001 , $25,000,000
P3 =$25,000,001 - $50,000,000 P4 =More than $50,000,000
3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessm ent T =Cash Market
(See Column C2) U=Book Value V=Other W=Estimated
c
(I)
(J-P)
35.
37.
44.
45.
FINANCIAL DISCLOSURE REPORT
Page 6of12
Name of Person Reporting
Debevoise, Dickinson R.
Date of Report
04/02/2009
.VII. INVESTMENTS and TRUSTS -income, value, transactions (Includes those of spouse and dependent children; see PP· 34-60 of filing instructions.)
0 NONE (No reportable income, assets, or transactions.)
A. B. c. D.
Description of Assets Income during Gross value at end of Transactions during reporting period
(including trust assets) reporting period reporting period
(I) (2) (2) (I) (2) (3) (4) (5) Type (e.g., Value Value Type (e.g., Date Value GainPlace "(X)" after each asset Amount Identity of
Code I div., rent, Code 2 Method buy, sell, Month- Code 2 Code I exempt from prior disclosure buyer/seller (A-II) or int) Code 3 redemption) Day (J-P) (A-II) (if private
36.
(Q-W) transaction)
-General Electric Com. Buy 2/11 J
-Johnson & Johnson Com.
-IBM
38. -Medtronic Inc.
39. -Bank of America
40. -Bank of America
41. -Exelon Corp.
42. -Duke Realty Corp.
43. -Harbor Fund International
Sold 2/11 J B
Buy 2/11 K
Sold 6111 J A (part)
Sold 2/11 J (part)
Sold 2/11 J A
-United Technologies Com.
-Wyeth Com. Sold 2/11 K A
46. -U.S. Treas Inflation Proj.
47. -Coca Cola Sold 2/11 J B (part)
48. -Lehman Bro. 6.375% pfd Sold 3/31 K A
49. -Proctor & Gamble Com.
50. -Marathon Oil Com.
51. -McDonald Com.
I. Income Galn Codes: A =Sl,000 or less B =Sl,001 • $2,500 c =$2,501 • $5.000 D =$5,001 - $15,000 E =S "·001 - S50.000 (See Columns B 1 and D4) F =$50,001 -$100,000 G =$100,001 -Sl,000,000 HI =Sl,000,001 • $5.000,000 H2 =Mon: than $5,000.000
2. Value Codes J =$15,000 or less K=$15,001 • $50,000 L =S50,00I - SI 00,000 M =SI 00,00 I - $250,000 (See Columns Cl and DJ) N =$250,001- $500,000 0 =$500,001 • $1,000,000 Pl =$1,000,001- $5,000,000 P2 =$5,000,001. $25,000.000
P3 =$25,000,001 • $50,000.000 P4 =More than $50,000,000
3. Value Method Codes Q=Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market
(See Column C2) U =Book Value V=Other W=Estimated
VU:
53.
55.
56.
A.
(I) (I) (I)
D.
(3)
Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT
Page 7of12 Debevoise, Dickinson R. 04/02/2009
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; see PP• 34-60 of filing instructions.)
0 NONE (No reportable income, assets, or transactions.)
c.
Gross value at end of
B.
Transactions during reporting period Income during Description of Assets reporting period reporting period (including trust assets)
(2) (2) (2) (4) (5) Place 11 (X)11 DateValue Value Value GainType ( e.g.,Amount Type ( e.g., Identity of after each asset
Code I Method buy, sell, Month- Code2div., rent, Code2 Code I buyer/sellerexempt from prior disclosure (A-H) redemption) Dayor int) Code 3 (A-H) (if private (J-P) (J-P)
(Q-W) transaction)
52. -Fed. Nat'! Mort. Assn. Matured 3/19 J A
-Citigroup Cap. XVII
54. -Federated Strat. Value (SVAAX) BUY 2/11 L
-Bank ofN.Y. Mellon
-America Movil Sold 12/18 J A
57. -Northern Trust Corp. BUY 10/15 K
58. -AT&TCom. BUY 6/29 J
59. -J.P. Morgan Chase Buy 2/11 J
60. -Fed Home Ln Bk Bonds 2015 Buy 3/31 L
61. -Bergen Cty IMRT Auth 2014 Buy 4/14 L
62.
63.
UBS Pace Fixed Income Fund (Formerly P. W. Invest. Account)
Hartford GP A V
D
A
Dividend
Interest
M
K
T
T
64. Management account at PNC Bank, See See VIII
65. -Blackrock Money Market Fund B Interest K T
66. Verizon Com. (Bell At!) B Dividend K T
67. Chevron Texaco Corp. Com. A Dividend K T
68. Johnson & Johnson A Dividend K T
l. Income Gain Codes:
(See Columns Bl and 04)
2. Value Codes
(See Columns Cl and 03)
3. Value Method Codes
(See Column C2)
A =$1,000 or less
F =$50,00 I -$I 00,000
J =$15,000 or less
N =$250,001 -$500,000
PJ =$25,000,001 - $50,000,000
Q =Appraisal
U =Book Value
B =$1,00 I -$2,500
G =$100,001 - $1,000,000
K =$15,001 -$50,000
0 =$500,001 -Sl,000,000
R =Cost (Real Estate Only)
V=Other
c =$2,501 -$5,000
HI =$1,000,001 -$5,000,000
L=S50,00l-$100,000
Pl =Sl,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 =$15,001 -$50,000
FINANCIAL DISCLOSURE REPORT
Page 8of12
Name of Person Reporting
Debevoise, Dickinson R.
Date of Report
04/02/2009
VII. INVESTMENTS and TRUSTS income, value, transactions (Includes those of spouse and dependent children; see PP· 34-60 of filing instructions.J -
0 NONE (No reportable income, assets, or transactions.)
A. B. c. Description of Assets Income during Gross value at end of
(including trust assets) reporting period reporting period
(I) (2) (I) (2) (I) Place "(X)11 after each asset Amount Type (e.g., Value Value Type (e.g.,
exempt from prior disclosure Code I div .. rent, Code 2 Method buy, sell, (A-H) or int.) (J-P) Code3 redemption)
(Q-W)
69. Exxon Mobil Corp. Com. B Dividend L T
70. .. N.J. EDLFACS Auth. Due 7/01/20 B Interest K T
71. IBM Corp. Com. A Dividend J T
72. - Hammonton 4.75% due 7/01/18 B Interest L T
73. - Margate City 4. 75% due 2/0 Ill 7 B Interest L T
74. - Middlesex Co. Due 6/15/18 B Interest K T
75. General Dynamics Corp. Com. A Dividend J T Sold (part)
76. Bank of America Com. A Dividend J T
77. - Cape May Cnty. 4.50% due 8/15/20 B Interest L T
78. FPL Group, Inc. Com. A Dividend J T Sold (part)
79. -New Brunswick Pkg. Auth. 4.25% B Interest L T 9/1/15
80; -Old Bridge Twp. Bd. ofEd. 4.75% B Interest K T due 7/15/18
81. BAC CAP Trust II PFD B Dividend K T
82. Duke Realty Com. A Dividend Sold
83. Harbor Intrl Fund II A Dividend K T
84. U.S. Treas Notes 4.25% 8/15/13 B Interest K T
85. U.S. Treas Notes 3.375% 9/15/09 A Interest K T
1. Income Gain Codes: A 41,000 or Jess B =$1,001 -S2,500 c =$2,501 - $5,000
(Sec Columns Bl and 04) F =$50,001 -$100,000 G =SI00,001 -Sl,000,000 Ill =$1,000,001 -$5,000,000
2. Value Codes J =$15,000 or Jess K =$15,001 -S50,000 L =$50,001 • SI00,000
(Sec Colunms Cl and 03) N =$250,001 -$500,000 0 =$500,00I - S 1,000,000 Pl =$1,000,001 -$5,000,000
P3 =$25,000,001 -SS0,000,000 P4 =More tbao $50,000,000
3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment
(Sec Column C2) U =Book Value V =-Other W=Estimatcd
D. Transactions during reporting period
(2) (3) (4) Date Value Gain
Month- Code 2 Code I Day (J-P) (A-H)
2/11 J B
2/11 J c
2111 J A
D =$5,001 -$15,000
H2 =Mon: than $5,000,000
M -SI00,001 -$250,000
P2 =$5,000,001 - $25,000,000
T =Cash Market
(5) Identity of
buyer/seller
(if private
transaction)
E =$15,001 -$50,000
(I) (!)
A
A.
(2) (3)
87.
92.
93.
99.
Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT
Page 9of12 Debevoise, Dickinson R. 04/02/2009
VII. INVESTMENTS and TRUSTS - income, vatue, transactions (Includes those of spouse and dependent children; see PP· 34-60 of fiting instructions.)
NONE (No reportable income, assets, or transactions.) D
Description of Assets
B. c. D.
Income during Gross value at end of Transactions during reporting period
(including trust assets) reporting period reporting period
(I) (2) (2) (4) (5) Place "(X)" after each asset
exempt from prior disclosure
Amount Code I (A-H)
Type (e.g.,
div., rent,
or int)
Value
Code 2
(J-P)
Value
Method
Code 3
(Q-W)
Type (e.g.,
buy, sell,
redemption)
86. Coca Cola A Dividend K T Sold
(part)
Date
Month-
Day
2/11
Value Gain Identity of
Code 2 Code I buyer/seller
(J-P) (A-H) (if private
transaction)
J
United Technologies A Dividend J T Sold 2/11 J B (part)
88. Wyeth A Dividend J T
89. Proctor & Gamble A Dividend J T
90. AT&T, Inc. A Dividend K T
91. U.S. Treas Notes 3/31/08 A Interest Matured 3/31 J A
94.
Fed. Nat'! Mtg. Assn. A Interest Matured 3119 K A
Blackrock N.J. Munn. Fd. 416 A Interest K T See VIII
General Elec. Com. A Dividend K T
95. PPI Corporation A Dividend J T Sold 2111 J c (part)
96. Citigroup Cap. XVII PFD. B Dividend K T
97. Dupont A Dividend K T
98. JSHARES Barclays l-3yr treas B Interest K T See VIII
M acDonalds Corp. Com. A Dividend J T
100. XTO Energy Inc. Com. A Dividend J T
IOI. T. Rowe Price Summit Mun A Interest K T
102. FED Strategic Value CLA B Interest J T Buy 2111 J
I. Income Gain Codes:
(See Columns BI and 04) 2. Value Codes
(Sec Columns Cl and 03)
J. 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 =SI00,001 - $1,000,000
K =$15,001 • $50,000 0 =$500,00 I - $1,000,000
R =Cost (Real Estate Only)
V=Other
c =$2,501 -$5,000
HI =Sl,000,00J -$5,000,000
L =S50,00I • $100,000 Pl =$1,000.001 '$5,000,000
P4 =More than $50,000,000
S =Assessment
W =Estimated
D =$5,001 - $15,000
112 =More than $5,000,000
M =$100,001 • $250,000 P2 =$5,000.001 -$25,000,000
T =Cash Market
E =$15,001 -$50,000
A.
Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT
Page 10of12 Debevoise, Dickinson R. 04/02/2009
VII. INVESTMENTS and TRUSTS -income, value, transactions (Includes those of spouse and dependent children; see PP• 34-60 of filing instructions.)
0 NONE (No reportable income, assets, or transactions.)
Description of Assets
(including trust assets)
Place "(X)" after each asset
exempt from prior disclosure
103. J.P. Morgan Chase A Dividend J T Buy 2/11 J
104. Bergen County Impt Auth A Interest K T Buy 4/14 K
105. Franklin Tax Free Fd 171 A Interest K T Buy 12/18 K
B. c. D.
Income during Gross value at end of Transactions during reporting period
reporting period reporting period
(1) (2) (1) (2) (I) (2) (3) (4) (5) Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of Code 1. div., rent, Code 2 Method buy, sell, Month- Code 2 Code 1 buyer/seller (A-H) or int.) (J-P) Code 3 redemption) Day (J-P) (A-H) (if private
(Q-W) transaction)
106. Blackrock Munic Bond Fund 324 8 Interest K T See VIII
1. Income Gain Codes: A =$ 1,000 or less B =Sl,001-$2,500 C =S2,501 - S5,000 D =S5,001 - $15,000 E =$15,001 -S50,000 (Sec Columns Bl and D4) F=S50,001-Sl00,000 G=Sl00,001 - Sl,000,000 HI =Sl,000,001-$5,000,000 H2 =More than $5,000,000
2. Value Codes J =$15,000 orless K=$15,001 - $50,000 L =$50,001 '. Sl00,000 M =SI00,001 -S250,000 (Sec Columns Cl and 03) N =$250,001- $500,000 0 =$500,001 - $1,000,000 Pl =$1,000,001 -$5,000,000 P2 =$5,000,00t - $25,000,000
Pl =$25,000,001 - $50,000,000 P4 C"Morcthan $50,000,ooO 3. Value Method Codes Q=Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market
(Sec Column C2) U =Book Value V=Other W=Estimated ..
•••••• 10-15.
FINANCIAL DISCLOSURE REPORT
Page 11of12
Name of Person Reporting
Debevoise, Dickinson R.
Date of Report
04/02/2009
VIII. ADDITIONAL INFORMATION OR EXPLANATIONS. (lndicate partofReporL)
From time to time the various Nuveen Funds make returns of principal as various bonds are redeemed.
Williams College Pooled Income Fund #3. I have set forth as the value of this item the amounts I placed in the Fund from time to time. I receive the income from the Fund but upon my death it goes to Williams College; therefore, the value to me would be the value of my life interest.
- Trust and Management Account:
Blackrock Money Market Funds are the equivalent of cash. The trustee or Fund Manager purchases and sells (deposits and withdraws) money from the Funds frequently. I have not listed each deposit and withdrawal and have set forth the December 3I, 2008 values.
During 2006 I transferred the cash and six tax exempt bonds listedjndividually in my report into a revocable trust of which I am trustee and over which I have complete powers of disposition. The purpose is to ensure that upon my death the assets will be available to help pay college education expenses Because I retain complete control over the assets I see no need to list them separately as part of a trust. The assets are listed in Part VII lines
Notes to - Trust Account (Part VII, lines 18-61): In my 2007 Report at Part VII line 20 I listed "Blackrock Funds NJ Tax Free Bonds." This asset is not listed in the December 2008 PNC report and upon
inquiry I was informed that it had not been a trust asset. It was listed in error in my 2007 Report.
Part VII Line 30. In my 2007 Report Part VII line 34 I listed this trust asset as "Blackrock Money Market Institutional." It is the account into which PNC deposits and withdraws cash and is now described as "Blackrock Liquidity Funds."
Notes to Management Account (Part VII Lines 64-106): Part VII, line 64. This is simply a header for the assets listed in lines 65-106.
Jn my 2007 Report Part VII line 78 I listed "Blackrock Fund N.J. Tax Free #92." This asset is not listed in the December 2008 PNC Report, and upon inquiry I was informed that checking back to 2005 there is no record of this asset being held in the account. It was listed in error in the 2007 Report.
In my 2007 Report Part VII line 104 I listed "Blackrock Mun. Ed. 37." This asset is not listed in the December 2008 PNC Report, and upon inquiring I was informed that PNC or Blackrock had not used that account for three years. It was listed in error in the 2007 Report.
Part VII, line 93. I listed "Blackrock NJ. NMunn Fd. 416" in my 2007 Report (Part VII line 107) as sold. It was not sold and is still held in the account. The 2007 Report should be corrected accordingly.
Part VII line 106. Blackrock Munic Bond Fund 324 was not listed in my 2007 report. Upon inquiring of PNC Bank I was informed that it was acquired on December 6, 2006 with a valuation of K. I apparently thought it was listed in the 2007 Report at Part VII line 104 as "Blackrock Mun Ed 27." (see above for that item).
I note that the custodian PNC Bank shifts funds in and out ofBlackrock account frequently and that these accounts have similar or changing names. This is the reason for the confusions noted above.
Part VII, line 98. My 2007 Report (Part VII line 112) I listed Lehman Index Fd. On November 26, 2007 there was received in exchange for this Fund !SHARES Barclays 1-3 yr treas.
FINANCIAL DISCLOSURE REPORT
Page 12of12
Name of Person Reporting Date of Report
Debevoise, Dickinson R. 0410212009
IX. CERTIFICATION.
I certify that aU 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.
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 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)
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