frank j polozola financial disclosure report for 2009

8/3/2019 Frank J Polozola Financial Disclosure Report for 2009

1/6

A o l0 I FINANCIAL DISCLOSURE REPORT R e p o r t R e q u i r e d b y t h e E t h i c sin G o vern men t Ac t of 1978Ray. 1/2010 [ FOR CALENDAR YEAR 2009 (s u.s .c , app. ~" 101-111)I . P e m n R e p o r t i n g ( l a s t n ~ n e , f i r s t , m i d d l e i n i t i a l ) 2 . C o u r t o r O r g a n l z a d o u 3 . D a t e o f R e p o r t

4 . T i t l e (A ~ d c l I l l ju d g e s i n d i c a t e a c ~ v e o ~ s a v o r s t a t u s ; 5 a . R e p o r t T y p e ( c h e c k a p p r o p r i a t e t 3 V e ) 6 . R e p o r t i n g P e r i o d

5b. [] A m e n d e d R ~ p o c t7 . C h a m b e r s o r O f f i c e A d d r c . ss & O n t h e b a s i s o f th e i a f o r m a t t o n c o n t a i n e d t a t h i s R e p o r t a n d a a y~ "~ 9 g 1~ ~. ~1~ ~ ~" ~. m o d i f i c a t i o n s p c r t a f m i n ~ t h e r e t o , i t i s , i n m y o p i n i o n , i n c o m p l i a n c ew i t h a p p l i c a b l e la w ~ a n d r e g u l a t i o m .

I M P O R T A N T N O T E S : The ins truc t ions accom panying th is form must be followeg Complete all parts,checking the N O N E b o x for each part where you have no reportable information. Sign on last page.


2/6

B . S p o u s e s N o n - I n v e s tm e n t I n c o m e - If you were married during an)portion of the reporting year, complete this sectiar~(Dolla~ amou nt not required except for honoraria.)[~ NONF, (No reportable non-investment income.)

DATE S O U R C E A N D TyP~1.

2.

3

4

IV . REIMB U R S E M E N T S - ~ ,~ p o ,~ o ,~ So~ g~ng, /ood, , , ,~, , ,~ .. ..~(Includes those to spouse a nd dependent children: see pp. 25-2 7 of fil ing instructions.)

[~ N O N E (No reportable reimbursements.)~ DATES LOCATe[ON PU R PO SE IT E M S P A ID OR PR O V ID E D

1 .2.

3.4.

5.


3/6

F INA NC I A L DI SC LOS U RE R EP OR T Name of Person Reporting [ Date of Report

~ NO~ ~o reportable g~ts,)~ DESC~P~ON

I.2.3.4.5.

V I . L I A B I L I T I E S . a , ~ t u , t e , ~ o , , o ~ , o . ~ . ~ , , ,~ a , ~ , ,a ~ , ~ t h U d , e , , ,. s e e p p .~] NONE (]go reportable liabilities.)

C R E DIT O R DESCRIPTION!234.5.


4/6

FINANCIAL DISCLOSURE REPOR TPage 4 of 6 |

~. I~STMENTS and TRU S TS -i ~~ NO~ ~o rePo~able income, ~sets, or ~sactionsO............................~. ~ , . . . . . . . . . . . ~ . . . . . .. . . . .. . . . . . . ~ ........................ ~. . . . . . . . . . . . . . . . . . . . . . . . . .. . .~ of As~ ] ~c~ ~ng Gr o ss v ~ u ~ a t ~ d Tr~cfons ~g ~g p~{including ~t ~s~) [ rep~g ~od

Pla~ "(X)" a~ ~ch ~t ~ ~o~t ] Type (e.g., ~ V~ue Value "ry~ (g, Date V~u i Gain [d~fi~ of~x~pt~pfiordi~losur~ Co~ l [ div,r~t, C o d ~ 2 Me~ : b~,sell, ~ n ~ / d d ~ T C~e2 ~ C~e 1 b~/seller

2.

3.

1 4 .

1 5 .

]6 .

1 7 .

(See Colmnn C2) U :B ook Value V ~Oth~ W ~ .~ i rrm t ~ d


5/6

FINANCIAL DISCLOSURE REPORT

V I II . A D D ITIONA L I NF OR M A TI ON OR EX P LA NA TIONS .


6/6

FINANCIAL DISCLOSURE REPORT

IX. CERT IFICATION.I cert i fy th at al l informat ion given above (including informat ion pertaining to m y spo use and minor or dependent chi ldren, i f any) isaccurate , t rue, and com plete to the best of my knowledge and belief, and that any informat ion not reported was wi thheld because it m et applicable s tatutory.provisions perm itting non-disclosure.I farther cert i fy that earned incom e from outside emp loym ent and honoraria and the ac ceptance of gif ts which have been reported are incom pliance w ith the provisio ns of 5 U.S.C. app. 50 1 eL seq., 5 U.S.C. 7353, and Judicial Conference regulations.

NOTE: ANY INDIVIDUAL W ttO KNOW INGLY AND W ILFULLY FALSIFIES OR FAILS TO FILE THIS REPOR T MAY B E SUBJECT TO CI~qLAND CRIMINAL SANCTIONS (5 U.S,C. app. 104)

FILING INSTRUCTIONSMail signed original and 3 additional copies to:

Committee on Financial DisclosureAdministrative Office of the United States CourtsSui te 2 - 30 1One Columbus Circle, N.E.Washington, D.C. 20544

frank j polozola financial disclosure report for 2009

Documents