susan h black financial disclosure report for 2009

8/3/2019 Susan H Black Financial Disclosure Report for 2009

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, .~ o t o I FINANCIAL DISCLOSURE REPORTm , , . . 1 / 2 O l O [ FOR CALENDAR YEAR 2009 ~ . ~ u . s c . , I ,p ~ , " . ~ " ~ o ~ - ~ l l ~I . P e r s o n R e p o r l i n g ( l a . ~ t n a m e , f i r s t, m i d d l e i n i t ia l } 2. Conr t or Organ iza t ion 3 . D a t e o f R r p o r t1 3 l a c k . S u s an H . U. S . C o u r t o f Appc :ds 0 5 ~ 0 6 , 2 0 1 0

4 . T i t l e ( A r t i c l e l l I j u d g c s i n d i c a t e a c t i v e o r s c n i o r s t a t u s ; S a R e p o r t T y p e [ c h c c k a p p r ~ p r i a tc ~ y p )6 . Repor t ing Pe r iod

m a g i s t ra t e j u d g e s i n d i c a l I h l l - a t p a d - d i n e ) ~ N o m i n a t i o n . D a ~ 0 1 , 0 1 , 2 0 0 9Ci r cu i t J ad g o -Acd v ~ In,tial ~ Annual ~ Final 12/31/2000Sb. ~ Amended

7. Chambers or Office Address 8. On the b as i s of~he informat ion contained in ~ h l s R t p o ~ a n d a n ym o d i f i c a t i o n s pe~aialng there lo, I t i s , I n m y opinion, In c o m p l i a n c e30 0 N H oga n S t r e e t ~ l~h appl i cable l aw~ and regu la t ions .Su i t e 14 - 15 0Ja c ks onv i ll e , F L 3 220 2- 4 25 8 Reviewing Officer D a t e

I M P O R T A N T N O T E S : The instraction$ accompanying this form must be followe,~ Com plete all parts,checking the NONE box for each part where you have no reportable information. Sign on last page.

I . P O S I T I O N S . m , ~ o r a ~ x t o a ~ t a ~ o t o ~ t ~ ; , , , v v . ~ . l ~ o ~ ~ t i ,~ t ~ s ~ r ~ , , t o , ~ )D NONE (No reportable positions.)

P O S ITIO N NA M E O F O R GA NI ZA TI O N/ E NTI TYI. Trustee ~ Life Ins. Trust {Part VIII)

[-~ N O N E (No reportable agreements.)D A T E PARTIES AND TERMS


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N a m e o f P e r s o n R e p o r t in g D a t e o f R e p o r tP a g e F IN A N C I A L 2 o f 8 D I S C L O S U R E R E P O R T a ack , S u s a n 1 1 . 0 5 , 0 6 2 0 1 0

IIl. NON-INVESTMENT INCOME. tRepora,~,~h,ld,,=tond.~p ..... . - ,e , p p .A. F l i e r s N o n - l n v e s t m e n t I n c o m e

NONE (No reportable non-investment income.)SOURCE AND TYPEATE _ _ ( yours , no t sp o u se s )

1 . 2 0 0 9 D u k e Un i ve r s i t y S ch o o l o f L aw-ap p e l h t e p r ac t i ce co u r se $4 ,500 .00

2. 2009 Flo r ida S t a t e Un iv e r s i ty C o l l e g e o f L o w - ju r i s t- i n - re s lde n c e $2,000 .00

3 .4.

B . S p o u s e s N o n - I n v e s t m e n t I n c o m e - if you were married daring any portion of the reporting year, complete thls secttott( D o l l a r a m o t t t f f n o t r e q u i r e d x c e p t f i ~ r h o n o r a r i a . )

[~ N O N E (No reportable non-investment income.)D A T E SOURCE AND TYPE

I . 2009 S e l f - em p lo y ed p r e s i d en t o f t r ave l ag e n cy

2. 2009 S e l f - em p lo y ed r ea l e s t a t e b r o k e r

3. 2009 S e l f - em p lo y ed o w n er o f l l m o se r v i ce

4.

I V . R E I M B U R S E M E N T S - t~..,,~onaa,,n, toa~.t,/oo,t, ..,..,a,,m.n"( l n c l u d e ~ t l u , s e to s p m t s e a n d d e p e n d e n t c h i l d r e n : s e e p p . 2 5 - 2 7 o f f i li ~ i ~ r r u c t i o n s . )

~ N O N E (No reportab& reimbursements.)~ ~ L O C A T I O N PURPOS~ ITEMS PAID OR PROVIDED

1 . Th e F lo r ida B ar Ju n 2 5 , 2 0 0 9 Or l an d o , F L R o u n dta b le Mile a g e , me a l

2 . Florida State Universi ty S e p 2 0 - 2 2 , 2 0 0 9 T al lah as s ~, FL Tea ch Mile a g e , me a ls , h o te l

3 . Du k e Ua iv e ~ ity Nov 15 - 17 , 20 0 9 D u r h am , N C Te a c h H o te l4 .5 .


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FINANCIAL DISCLOSURE REPORT N . m e o f P e r s o n R e p o r t in g D a , r o f R e p o r tPage 3 o f 8 m . k , S u s a n t l. 0 5 / 0 6 , 2 0 1 0

~ NONE (No reportable g~fis.)~ D E S C R I P T I O N VAL~

1 .2.3.

5.

V l . L I A B I L I T IE S . (Indudes those of sp ...... a d~enaent ct, ildrtne s~. 32-33 0f filing instructlonsd~ NO NE (No reportable liabilitiesO

CREDITOR ~ ~1 . B an k o f A me ric a Mo n g ag e-P ar ce l 3 3 ( P aR V I I , li n e 1 8 ) PI

2. S u n T r u s t B an k M o rtg a g e -P a re d 3 9 (P a a V II , l i n e 3 6 ) M

3 . Mer can t il e B an k Mo r t g ag e -P ar ce l 3 8 ( P a~ VI I , l i n e 2 5) N

4. P H H M o ag a g e Mo ~g ag e-P ar ce l 40 ( P a ~ VI I , l i n e 3 8 ) M

5 . C o l d w e l l B a n k e r M o a g a g e Mo r t g ag e-P ar ce l 41 ( P an VI I , l i n e 3 9 ) L


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N a m e o f P e r s o n R e p o r t in g D a t e o f I t c p o r tP a g e F I N A N C I A L 4 o f " 8 D I S C L O S U R E R E P O R T a l a c k . S u s a n n . 0 ~ , 0 ~ , 2 0 t O

N O N E ( ~ V o reportable income, assets, or transactions.)D ~ c r ; p t i o n o f A s ~ t s I~ome d~ing G r o s s v a l u e a t e n d T r a n s a c t i o n s d u r i n g r c p o n l n g

~ i ~ . l u d i n g t n ~ s t a s s e t s ) t e p o ~ i n g p e r i o d . vfrcpoaing pe r iod .11) (2) : 11) (2) "(I) ....... (2) O) (~ ....... (5) ....P l ~ e " { X F a f l ~ e a c h ~ s c t A m o u n t T y p e ( e . g ., Value V a l ue T y ~ ~ c . g ., D a t e V a l ue Gain I d e n t i t y

e x e m p t f r o m p r i o r d i s c lo s u r e C ~ I d i v . , r e n t , C~2 Mc~ buy, sel l , m n x ~d ~y y . C o d e 2 C o d e I buyerse l le r{ A - H ) o r i n t . ) ( J . P } C ~ e 3 ~dcmption) { I - P ) (A-Ill ( i f p r i g a t e( Q .% ~ t r a n s a c t i o n )

I. R eal E s t a t e P a r ce l 2 Am el i a I s l an d , F L A R e n t J W

2 , R ea l E s t a t e P a r ce l 5 J ac~o n vi l l e , F L Non~ O W

3. R eal E s t a t e P a r ce l I 0 J ack so n v i l l e , F L None M W

4. R eal E s t a t e P a r ce l 1 3 J ack so n v i l l e , F L ( Y )5. Wel l s F ar g o IR A ( f o r mer l y Wach o vi a) A Int. /Div. K T

6. -Ca l am o s Co n v O p p o r tu n i t i e s & In co m e F d

7. . D WS In ve s t m en t Tr u s t Cap i t a l G r o wt h F dC I B8. -Wel l s F ar g o B an k D ep o s i t ( f o rm er lyWaeh o vi a)

i 9 . -E ve r g r een E q u i t y T r Asse t Al l o ca t i o n F d CIC1 0 . Wel l s F ar g o IR A ( f o r mer l y Wach o vi a) A Int ./Div, J T

I I . -E ve r g r een E q u i t y T r Asse t Al l o ca t i o n F d CI S o l d 01 / 2 0 / 09 KC1 2 . -BIackrock IncomeTmst Inc S o l d 01 / 2 0 / 09 J

1 3 . -Wells Fargo Bank Deposi t ( formerly C l o s e d 01 / 2 0 / 09 LW uc h ov l a )1 4 . -Ca]amos Strateg ic Total Return Fd S o l d 01120 /09 J

1 5 . -Cea t u ~ P r o p e r t i e s F u n d X V L P

1 6 . Real Estate Parcel 29 Mars Hi l l , NC C R e n t N W1 7 . R eal E s t a t e P a r ce l 3 1 J ack so n v i ll e , F L A R e n t M W

3 V a l u e M c t h t ~ C o ~ s Q = A p p r a i ~ l R . . C o ~ t R e a l E s t a t e O n l y ] S - A s s g ~ g m e n l T ~ a s h M a r k et


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FINANCIAL DIS CLOS URE REPO RT N , m e o fP a g e 5 of 8 B l a c k , S u s a n I I . I 05 , O6 / 2010

V I I . I 1 N V E S T M E N T S a n d T R U S T S - ~ ........ , . t .~ ,N O N E (No reportable income, assets, or transactions.)

A, B. c. D .D c s c r i p t i o n o f A s s e t s I n c o m e d u r i n g G r o s s v a l u e a t e n d T r a n s a c t i o n s d u r i n g r e p o r t i n g p e r i o d[including[rust a~cts) r c l m r t i n g p c r i o d i of repor t ing per iodII) ~ (2)

P I a c e " [ X ) " a f t e r e a c h a s s e t A m o u n t . T y p e ( g ., i V a l ue Value T ) p c ( e . g . . ! Date !Valuc Gain I d e n t i t y o fe x e m p t f r o m p d o r d i s c l o su r e C o d e I d i v . , r e n t , I Code 2 M c d ,o d buy, sel l , m m , d d ; y y i C o d e 2 : ; C o d e I buyer /se l l e r (A-H ) ! o r i n t . ) ~. ( J - P ) C o d e 3 : rcdcmption} ( J - P ) ( A - H ) [ i f p r i v a t e: l ( Q - W ) . J . . :. . l i I r a n s a c t i o n )

1 8 . R eal E s t a t e P a r ce l 3 3 Or an g e P ar k , F L G R e n t Pl W19 . Loaa-Plumlee A Interest J U

2 0 . R eal E s t a t e P a r ce l 3 4 Mt P l easan t . IA D R e n t S o l d 02/01/09 O L e i g h B l ack

21 . R e a l E s ta te P a rc e l 3 5 C o co a , F L No n e S o l d 0 2 /0 1 /0 9 O L e i g h B l a c k22. R e a l E s t a t e P a r c e l 3 7 J a c k s o n v i ll e , F L N o n e L W2 3 . Loan-Smith N o n e J U2 4 . S u n r r u s t acco u n t s A Interes t J T

2 5 . R eal E s t a t e P a r ce l 3 8 J ack so n v i l l e , F L None O W2 6 . L o m -S . K . Ho n g l n c E Interes t M U

2 7 . L o a n - S m i th 2 N o n e K U2 8 . L o an -B ra g g No n e J U

2 9. L oa n-H ew ntt 2 None K U3 0 . Loan-Norman None J U3 I. Loan-Norman 2 None J U

32 Loan-Lab Inves tments D Interes t M U3 3 . Loan-For t e D In t e re s t L U3 4 . C on~ pa s s Ba nk a c c oun t s None J T

PJ ~ $25,~,~1 $50,~.~ P 4 = M a r e t h anl S ~ C o l u m n C ~ ) U " B ~ k V a l ue V - ( ~ h c r W = E s t i ~ le d


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F INA N C IA L D IS C L O S U R E R E P O R T N,m, of Person Repor t ing Date of ReportP a g e 6 o f 8 B l a c k , S u s a n t l . 05. 06/2010

N O N E (No reportable income, assets, or transactions.)D e s c r i p ti o n o f A s s e t s ~ Income durin~ Gross value at end . Transac t ions dur ing r e por t ing pe r iod

r epor t i ng per iod of r cpor t i r t g per iodt including t r us t a s s c ~ s ) ~. ..............P l a c e ( X ) "a f ~ c r e a c h a s x c t Amout~l ! Type(e.g., : V a lu e V alu e T y p e ( e . g . , Date V a l u e Gain I d e n t i t y o f

e xe mpt f rom pr io r d i sc losu re i Code I , div. , r e n t , C o d e 2 Method . buy, se l l . mm , dd /y y " C o d e 2 C o d e I bu, , e r , s l l e r (A-H ) * ~ o r int.) ( J -P ) C o d e 3 r e d c m p t i o n ) t (JP) ( A - I l l ( i f p r iva te ( Q - W ) [ ; I t r ansac t ion)

3 5 . Mercantile Bank accounts A Interest J T

3 6 . R eal E s t a t e P a r ce l 3 9 J ack so n v i l l e , F L N o n e M W

3 7 . M i d A t la n t i c R e s id e n t i a l In v e st or s L P B D i s t r i b u t i o n J W

3 8 . R e a l E s ta t e P a r c e l 4 0 J a c k s o n v i l le . F L D R e n t M W

3 9 . R eal E s t a t e P a r ce l 41 J ack so n v i l l e , F L D R e n t L W4 0 . Loan-Grumling N o n e J U

4 1 . L o an -G i b so n C In t e re s t K U4 2 . Loan-Gibson 2 B Interes t K U

4 3 . B an k o f Am er i ca acco u n t s N o n e J T4 4 , R eal E s t a t e P a r ce l 42 l ack so n v i l l e . F L None M W4 5 . Loa n- Bl a c k I D Interes t O U Op en 02/01109 O4 6 . L o ~ - B l a c k 2 D In t e re s t O U Op en 02/01109 O4 7 .

I Income GainCodcs: .....A=$l .00O or le ss B.-$1 , 0~1 . $2 .J00" C ~$2.~01- S5 ,0~ D,,$J,~I-$1~.~ E = $ 1 5 , ~ 1 - $ 5 0 . 0 ~( S c C l ~ l u ~ s 1 3 1 a n d D 4 ) F , $ 5 0 . ~ 1 - $ 1 0 0 , ~ 0 G - $ 1 ~ , ~ 1 $ 1 . ~ . 0 t ~ I II -~il.~.~l - SL~,~ 1 1 2 = M o r n t ha n2 V a l u e C r i e s J " $15 ,0~ or l es s K . . . I 1 5 . ~ I - $ ~ . ~ L ~,$50 ,~ I - $ I ~ .~ M : ~ $ 1 0 0 , 1 ~ I - $ 2t~e Cola,n~s C I and D3} N ,-1250 .~1 55~.0~ O =15~.~1 - $1 .~.~ P t " . ~ $ 1 , ~ ) .~ 1 $ 5 , ~ . ~ 0 P 2 = $ 5 . ~ . 0 0 1 -P3 =$25.~.~! $50.~1).~ P 4 " * M o ~ t h a nJ Vah~ Nt~h~ Codes Q = A p p m i s* l R -C t~ (Rea l E s ta te O nly ) S =Assessment T =Cash Market{ S e e C o h a n n C 2 ) U~k Valtg V - O t~r W . ~ E s t i m a t c d


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. ~a m e o f p e r son Re p nr l l n~ Date o~ Repor tFInAnCIAL DISCLOSURE REPORT ~ ~ck , s~ ~.a g e 7 o f 8V I I I . A I ) D I TI O N A L I N F O R M A T I O N O R E X P L A N A T I O N S . e t , d l , a ~ e p ,, ,

P a n I - ~ L i fe I n s u r a n c e T r u s t - n o t l i s te d i n P a r t V I I , a s i t is a n u n f u n d e d ~ r u s t .


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FINANCIAL DISCLOSURE REPORT IP a g e 8 o f 8 ! [ Black, Susan ll.I

05. 06/2010

IX. CERTIFICATION.I ce r t i fy th a t a l l in for mat ion g ive n ab ove ( inc lud ing infor mat ion p e r ta in ing to my s p ous e and minor o r d e p e nd e nt ch i ld r e n , I f any) I s

a c c u r a t e , t ru e , a n d c o m p le t e t o t h e b e s t o f m y k n o w l e d g e a n d b e l i e f , a n d t h a t a n ) i n f o r ma t i o n n o t r e p o r t e d w a s w i t h h e l d b e c a u s e I t m e t a p pl i c a b l e s t a tU t o r ypro v l s io n ~ pe rm i tt i n g n o n -d i s c lo s u re .I f u r t h e r c e r t if y t h a t e a r n e d i n c o m e f r o m o u t s i d e e m p l o y me n t a n d h o n o r a r i a a n d t h e a c c e p t a n c e o f g i f t s w h i c h h a v e b e e n r e p o r t e d a r e I nc o m p l ia n c e w i t h t h e p r o v i s i o n s o f 5 U . S . C . a p p . 5 0 1 e t . s e q . , 5 U . S . C . 7 3 5 3 , a n d J u d i c i a l C o n f e r e n c e r e g u l a t io n s .

N O T E : A N Y IN D IV I D U A L W H O K N O W I N G L Y A N D W [ L F U L L Y F A L S I F I E S O R F A L L S T O F I L E T i ll S R E P O R T M A Y B E S U B J E C T TO C I V I LA N D C R I h ~ IN A L S A N C T I O N S ( 5 U . S . C . a p p . 1 0 4 }

FILING INSTRUCTIONSM a i l s ig n e d o r i g i n a l a n d 3 a d d i t i o n a l c o p i e s t o :

C o m m it t e e o n F i n a n c i a l D i sc l o s u r eA d m i n i st r a ti v e O f fi c e o f t h e U n i t e d S t a t e s C o u r t sS u i t e 2 - 3 0 1O n e C o l u m b u s C i r c l e , N .E .W a s h i n g t o n , D .C . 2 0 5 4 4

susan h black financial disclosure report for 2009

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