a1al 0 l'' · 2019-07-26 · e and ryre 1213104 i\1etlife iltf1xed income from vested...

9
U.D.S . C ., EAST. DIST L 5 . R e prType (check appropri: u e l ype) (5 u. s.c. pp§ 101-1 1 1 ) J. Oce of R<J1 605 6. Rtpo rti ng Perio 4. T i tl e (N1i¢le UJ Judges i nd ica te ac1i ve o senior s1.tus : m:gjstr:ue judgtS ind u : a te f ull· or p3n-u m) n a a 10 1 2/ 31/04 ____________ _ Date ____ _ ! ,. 1 PORTANT NOT: Te intruc tions a ccompanyin g this form mus t b folloR ' e d . Complete all parts , choking the NONE box for each part e COVENANT HO USE, NON- PROFIT ORGANIZATION c f m PAR TES A D TRS I. 0 ( " ,.r - : . ) - 0 AO·IO ne, .. 11200 4 FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2004 I. Per Rng (Lt n:n', First nam, 1'idilc 1ni1iAI) 0. ·1I, Stawo R 2. Con oOramz;110 Reprt Required by rhe Ethics in Co,ernment Act of 1978 0 Nt100. Date 7/l;1994 l/112004 U.S.O.C. ACTIVEJE 7. Chambe o Ofice Addr es 500 Pr St.. R C-368 NtwOls. L 70130 Q hulial ( A11l 0 F"' 8. On the basis of Lhe 1nfnn:tio contine in Ehis Re p and any mifications penaining lh10. i1 is, in my opinion, in eorli nce v.ith applicable laws nd rcgu'31ions. Rie \ing O fi cer J. POSITIONS. (R poning iod1v1dual oJy; sec p. 9·1 J of filing instctions) 0 NONE - (Nu rable posi1ions.) PD I. NAME OF 0RCANlTIONENTITY I. AGREEMENTS. (1ing individual onl:sc pp. 14-16of ilingins11Ucrions) f NONE - (o rble agrcc elS.) ... o- ( : c: :: ,'( o) " .. = = '-" c = " .: m ( m - < m 2. BOARD OF DIRR J.

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Page 1: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

U.D.S . C ., EAST. DIST LA

5 . Repo rtType (check appropri: u e lype)

(5 u.s.c. • pp.§§ 1 01-1 1 1 )

J. O.ce of R<Jl0<1

61312005

6. Rtporting Period 4. Title (N1i¢le UJ Judges indic a te ac1ive or senior s1.atus :

m :agjstr:ue judgtS ind u : a te full· or p3n-u me)

n

aa

10

1 2 / 31/2004

____________ _ Date ____ _

! ,...1PORTANT N OTES : The instructions a ccompanyin g this form must be follo'e d . Complete all parts , choe- king the NONE box for each part

e

COV ENANT H O USE;, NON- PROFIT ORGANIZATIO N

c f

m

PARTIES AND TERMS

I.

0 (/)

"

,..,r--.,

: .

.c

)> -

0

AO·IO

ne,.. 112004

FINANCIAL DISCLOSURE REPORT

FOR CALENDAR YEAR 2004

I. Person Reponing (Last n:an'IC:, First name, 1'.1idiJlc 1ni1i I)

0u..·1I, Stanwood R

2. Coun orOrgamz.;;1100

Report Required by rhe Ethics

in Co,·ernment Act of 1978

0 Nmnitlat100. Date 7/l;/1994 l/112004

U.S.O.C. ACTIVE Jl./DGE

7. Chambers or Office Address

500 Poydras St.. Rm. C-368

NtwOrlc>ns. LA 70130

Q hulial (!) A111tual 0 Fl"''

8. On the basis of Lhe 1nfonn:itio cont:ained in Ehis Report and any

modifications penaining lhere10. i1 is, in my opinion, in eornpli nce v.ith applicable laws nd rcgu'31ions.

Revie\loing Officer

J. POSITIONS. (R poning iod1v1dual onJy; sec pp. 9·1J of filing instructions)

0 NONE - (Nu reportable posi1ions.)

PQSIDDN

I.

NAME OF 0RCANl2ATION/ENTITY

II. AGREEMENTS. (Repor1ing individual only:sc pp. 14-16of ilingins11Ucrions)

fiZI NONE - (No reportable agrcc enlS.)

.. ..., o-(/) ::>: c::<> ::0::.: ,'T}('"') o);

"

......, = ='--" c_ = ""'

.:::0 m (") m -

< m

2. BOARD OF DIRECTORS

J.

Page 2: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

i

SOURCE AND ryrE

1 2 13 1 /04 i\1 et L i fe ilt.\/F 1 xed income from vested pension pl an

Harold J . Anderson Lease Acquisition. AOC

22,800

4,576

r

(

SOURCE ANP TYPE

I. 1 2131/04 AUD I O \VQRKS, INC. ( voiccover wor k ) S25 0 . 00

EgoPo Produccions -Acres.s in T. Wdbams, .. A House N oc M eant 10 S tand" SlS0. 00

SOURCE DESCRIPTION

FINANCIAL DISCLOSURE REPORT Name of Person Reporung

Du·•a.I, Stanwood R

m. NON-INVESTMENT JNCOME. (Rep<>rt;ng indi"iduol and SpOUS<; ... pp. 17-l• offiling insU'Uct ons)

A. Filer's Non-lnvcstn1ent Jncon1e

0 NONE · (Norcponablenon-in"est nl in..:ome.)

1.

Date of Report

61312005

GROSS INCOM£

()'OW'l. not sPQu.1r's)

2. 4/31/04

JV, REIMBURSEMENTS .. mnsp0r1ation, lodg;ng. food, mten>inmen1.

(Include$ those to sp0use ll'd dependent childrm. Sec pp 2S·27 ofin$rruccions.)

0 NONE · (Nos uch repornbl< rdmbu,..ements)

1.

2. 12.f.ll/04

B. Spouse's Non-Investment Income · (If )'OU \\.'CfC !Tt:lmed during any portion of lhe reporting year, please complete this sec1ion. Dollar ::11noun1 not required exoc:p1 for honora ia.)

0 NONE No reportable non-in,·estmenl income) -

Page 3: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

D[SCRIPTION

pESC8JP1JON VAUJECOOE

Dint of Ritpon FINANCIAL DISCLOSURE REPORT NomtofPmooRtpomn1

Duvol, SIOnwood R 6/3/2005

V. GIFTS. (ll>cloda1hos<1ospousunddq>encl<n1choldmt 5«119 28·31 ofonslrUchocs)

0 NONE . ''° s.ch "'P""1b1e 1:1t1s.1

SOIJRC'£

VI. LIABILITIES. (Includes ohose of spouse and depmdcn1 children. Sec pp. 32·3• of msuuctions.)

NONE (No r<panablc habilirics.) ·

CREDITOR

Page 4: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

N a me o f PtrSOn Rc p octing

Duval. Sianwood R

Date of Report

61312005 .

•• c.

i reporting: pe riod t e:porting period

(I) (2) ( I) ( 2 ) (I) If 001 C:X.C:Ol) t trom wsc11n1. n

(1) (3) (4) (SJ AnlOUlll TJ'!>< Value G :i m

bu)'. sell. Cod<2 C od e I inL)

S

J. PaJ'Ccl #I , Terrebonne P arish, Li\ s R e nt K IV

2. Par cel # 2, Te lTbonne Parish, LA Ren1 J w

3. •• Parcel # 3 , Tn'ttbo nne P arish, LA B Rcn1

4. • l'N Rf11R£MENT PLAN

s . Fordoche, Jnc. ( st ock) c in terest K

6 . • METLI FE F"ixod Index F und E ln!trtSt 'N T

7. •MET LIFE· AM G& I A Interest T

s. •MET LIFE· AM GLBL tntcrcst J T

9. • MET LIFE· HA ROKFV Interes t J T

1 0. •MET LIFE· KAR LC V lnt erest l T

• MET LIFE· SSRAUPF A lnteres1 J T

1 2. •• MAN AGERS SPEC IA L EQ UITY FD A bnerest l T so ld/liquid. 3/"04 l

1 3. • M ETl.ffE DIVERSIFIED FUND B ln l ece St K T sold/l i quid. 3 /04 K

1 4. •• M F S MASS INVESTOR GRO WTH I interes t T sold/Jiqu i d. 3f04 J

IS. •• PIF 'fa. 1 P FUND #24 Jnltr($t J Ts 3"04 A

16. · • T.R OWE PRICE Mll). C A P GROWTH ln tc:n:: S t T $Old/l iquid. 3 ·04 A

•• LEG l ON IN ST. VALUE REPORT FUND lnicrest T sold/liq uid. 3"04 A

I S . •• TEMPLETON INST FD S INC FG'N EQUITY ln!<r<SI J 3"04 )

I. lnco me /G:1 in C'odC$: A = S 1. 000 or IC$S B c = S2.5-01·.SS ,OOO 0 E

R k

( See C o h11 11.n Cl) u .. B ool: V alw: \" "01h i: r w .. E s u: J

FINANCIAL DISCLOSURE REPORT

Page I of3

VII. INVESTMENTS and TRUSTS ··income, \'Jih1t. cranscuio1'4 (lncludes 1ho.5¢ of1be spouse a!'ld dtpendco1 chiJ n. Sec pp. 3-4·S7 orJilins instructions.)

A. 0.

Descr ption 0 r Assas ll'ICOt'IY during Cil"OU \llluc at end of TttnSaetiOllS duri� reporting period

(includm U\1$1assets)

Pbee M(X)" aftrr each llHte (e.g. Valuie- V:11lur T)'?'C' (c..1. °'"" ldcnrity offrom prio.rdisclosure Codit I d,j._., ri:nL OJ Codd Method Month· bU)CJ/Sdlt1

(A·Hl (J·PJ Code 3 merger, D.>y O·P) (A·HI fiJpriv111c (Q·W) rc:denl>(ioo) ua�rion)

DNONE (No reportibk lllCQflle, au.eu.. Qf 1r.1n 1tl1QOS)

A

J w

w

J

·'

A

A

I I.

A

A

A l A

A sold/liquid. l

A J J

17. A l l

#134

A T soldfliquid. A

SER

=Sl.001·52.500 -ss,001.s1s, ooo • SIS.OOl ·S.S0.000

(See CollnlllS 0 I �nd [)a) F =s.so.001.s100.ooo G • Sl00.001·.Sl.000.000 HJ • s1.ooo.001.ss.ooo,ooo ft2 -Moirt lh::ita S.S.000.000

2. \'a?ueCodes: J =SJ5,000q.rku K SIS.001-SSO,OOO l • SSO.OOl·SI00.000 M ...SI00.001·1250.000

(S..:c C<tlimnl.$CI inJ DJ) N .. S 50.00Cl·S500.<l00 0 ... SS00,001·11.0:IO,QOO .. • SJ.000.00l ·SS..OQfJ.OOO Pl • ss.ooo,001.$1S,()()(l,OOO

PJ ... s2s.ooo.001.sso,ooo.ooo P4 .. $More th:m sso.000.000

3. Vab.lcMtlhOJ Codes Q .. AP9f"3isal R .. ('os1 ( talF.sutc O;llyi s •A»e.'SJOCOI T • Cash·l-lar tt

Page 5: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

Nan lt o f P erson R epon1ng

Duval, S tanwood R

D:He O f Rcpon

6 onoo5

1 9. •• P IM CO TOTAL RETURN FD #35

20. ·• PI M CO H IGH Y lELD

21. " VANGUARD GRO WTH INDEX

22. MJN E.RAL INTEREST· TE.RRE.BONNE PARISH

23. MINERA L INTEREST · TERREBONNE. P ARISH

24. " ARTISAN INT'L F UN D

25. .. OAKMA RK FUND

26. •• M FS EM E RG IN G EQUITY I

2 7. • • SE.LE.CTED AMERICAN SHARES

28. .. AMERICAN EQUITY FUND

29. •• LO N OL£Af' PARTNERS

30. •• T . ROWE MIDCAP EQUITY GROWTH FUND

3 1. JUDICIAL & JUSTICE. FE.D.CRJEDIT UNION

32. .. S EPARATE. PROPERTY N E N

33. ••• MERRllL LYNCH CMA A CCOUNT

34. '"MERRILL LYNC H IRA ACCOUNT·

35. '"M·L ACT F IDELITY ADVISO R MIDCAP FD

36. '"MERRILL LYNCH IRA ACCOUNT .CASll

.l. \ a• uc: Mrlbod Codr s

( S.:t Col1.1.nm Cl) LI ""' 0-0Qk V'lm.•

J)

\'

c. D.

l'q)Ql'tm J period r ptriod

<I) (l) ( I ) (2) (I ) If not c.. \tn1)t rm.u cbsc l0$1J/C'

(2) m (•) CS)

T)l)< Valur ti.y, selt Cod< 2 Cod< I

inL ) ""'II<'· ) (A·H)

IJ1ltl't$l I T 3"04 J

Interest J T sold/liquid, ) '04 J

lnlertSl T 3'04 J

Roy olly J w

Royall)' I w

A lntm:st T sold/liquid. 31'04 J

ln est I T so ld/li qu i d . 3f<l4 A

interes t T sold/liquid. lf04 J

h lletCSI J T S<ild.ll iquid. 31 '04 A

lnl<:resl T sold/li quid. 3!04 J A

Interest J T sold/l iquid . 3/'04 J

Intertst J T sold/liquid. 3J"04 J

A ltll.etCS I J T

Interest T

Div iden d T S OLD 1/) 5 J

Olva dcn d T SOLD 1115

lnlc:rc: Sl L SOLD 1/15

c D E

• O U K r w .. Estimated

FINANCIAL DISCLOSURE REPORT

Page 2 of3

VII. INVESTMENTS and TRUSTS

A.

Oescripcion of Assccs (1nduding U'\ISl HSCIS)

Place'"<Xr aJkr each asset txtJJ1>1 front prior d1sdoswc

116

I V STME TS:

FIDELITY ADVISOR GROWTHT

CIT

1. LooomciGain Code$:

(5« Column$ Bl and 04)

2. Val.r Codes;

IStt Colun•u Cl :md 03)

A =$1,000or u

F -SSO.OOl·SI00,000

•SI S.000 orJess

N • mo.ooo-ssoo,ooo

p) .. S2S,000,00J·S50, 000.000

Q aAppnisal

()

)(

0

R

8. I DC<xnc durin, Gross VlJuc a1 tnd or Tr.ltlSIQl:ions dwit1¥ 1'tporti11g pcriQd

An IWlt (t.i Va lue ValU( Type (cg, 01k: G;a.in Jcknbtyof Cod< I di\. m'll 0. Cock1 Method .Month· bu)<t:risdkr (A ·H} CJ·PJ Cod<J Doy (l·P (ifpri\<J.k

(Q-W) re<krq>tion) O'lllWC:tion)

A soldt1iquid. A

A A

A J soldJliquid. A

A

A

J A

A J

A I A

A J

A I

A A

A A

A K

A J

A J

A T J

• Sl,OOl·S2,SOO • S250i·S.S,OOO -ss.001.s1 s.ooo • SIS.OOi·S.50.000

.. SIOO.OOl·SI ,000,000 HT • 11.000.00l·SS,000,000 W -Mort tha11 SS.000,000

.. SJS.OOl·SS0.000 L • S.SO.OOl·SIOJ,000 M S!OO.OOJ-S2SO,OOO

• SSOO,OOl ·Sl.000,000 Pl .. s l.000.00l ·S.S.000.000 P2 ..ss.OOO.OOJ·SlS,000.000

P4 - SM<>tt thaa SS0,000.000

• C'osi(Resl Esutc:Only} s -A1okssmmt T • Cash+'Martn

Page 6: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

r

Duval, Stan w ood R

0<1te of Rcpon

61312005

VII. EST"MENTS and TRUSTS - incomt, \'3lue. mnsc,:il)OO$ ( 1 nc;ludcs 1host oftht S poost and dependenl c:tuld; c: n . S« pp . 3 4 - S J (lf fil i nt iMuuctiOl'.11.}

37. ••• JUDICL' L & JUSTICE F ED. CREDIT UNIO N

JS. 000 MERRJL L L YNC H IRRA ACCT.BANK ONE E

3 9 . ' " 'MERRJLL LYNCH IRRA ACC1" BA N K ONE

40. C HECKING ACCT, WHITNEY N ATL BANK

41. S AVINGS ACCT. @ WHl'INEY NATL BAN K

42 . ... ML FUND. GROWTH C

• 3 . ''' M L GLOBAL ALLOCA TIDN C

44. ... ML GLOBAL SMALLCAP

• .. y AN KAMPEN COMSTOCK F UND CLASS C

4 6 . BLACKROCK MANAG E D INC. PTFL CL C

( $« Column C2) U • BooJ< Vafut

B

,.

••

tt:pOrllllg period

(I) ( 2)

int)

A lntcres1

0 J v1dend

A 01vidcnd

A Interest

lnteres t

B lnlercsl

c lnlertsl

c In1eres1

D lnteres1

B lnt.eretl

S

• Other

c .

lCportiu.g period

(I) (l) (I) If oot c: .. >;CJlll'I trom dis elos urT

(2) (3) < • ) (S) Due: Va»< Ga"'

bu y, sc U . Cod< 2 CO<k l """"· (J-P) (A·HJ redc111>tion)

T

SOLD lilS

SOLD 1115

T

K T

L T BUY I/ IS

K T BUY I/I S K

K T BUY I/ I S K

L T BUY I/IS L

T BUY I/IS I..

c 2 D £

s .,......._ -Csih."M arke1

w • Estima: N

·FINANCIAL DISCLOSURE REPORT Page 3 of3

Name ofPe son Re\)On1ng

A.

Ocscn.ptioa of Assccs (indud.iog irust assets)

Pia« '"(X)" aftn ('3th lSSd tun 1 fiomprior disdosurt

PPAP P NION TRUST (X)

401(K) ROLLOVER

-

-

4.5.

toco1)11: dwin.g

""""'' T)pe (t,g. C<>de I d.iv. or (A·H)

_,

A

D.

<;irtn$ ' luc at md of Tr.umelions dun:ig repom1ii: period

Yahoo VaJut Type (t.g. ldentiryof Cock2 1ctbod Mootb • buyer/seller (l·Pl Cod<J 0.y (lf priva1t

(Q-\\� lnnSiO"bOO}

J

J T J

L T L

J

L

I..

I. lncoinelG3.iaCode:s: A •Sl.OOOork»

{5«('ulumns 01 oo 04) F • SS0.001.SlOO,OOO

;?. V::lue ('odes: J ..- SI 5.000 Of k

($« Coli.nm\S Cl and Dl) N •$2.SO.OOO·SS00,000

Pl •S2S.OOO,OOl·iSO,OOO.OOO

3. Valut Method Codes 0 • Apprai 1

G

K

0

R

• Sl.OOl· l..SOO

., SI00.001-SJ.000.000

• SIS.OOl·SS0.900

• S.S00.001 ·11.()00.000

• C.os1 (Real Esule Ontyl

=S 501·15,000 •SS,ODl·SJS,000 a SJS.OOl·SS0.000

HI = Sl.000.001-SS.OOO.OOO H1 • Mort lh:ln SS,000,000

l ,. SSO.OOl·SI00,000 M -s 100.001.s2so.ooo

Pl •$1.000,00l ·S.S.OOO.OOO P2 • SS.000,001-525,000.000

P• •$Mort 1h30 $50. 000. 000

T

Page 7: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

Oare of R.e-pol1

61312005

Name of Perwn ReportingFlNANClAL DlSCl.OSURE REPORT

Duval, Stanwood R

VIII. ADDITIONAL INFORMA TlON OR EXPLANATIONS

(I) TiiE ASSETS LISTED IN SECTION VU DESIGNATED WITH THE METUFE PREFIX ARE IN A WIDELY DIVERSE MUTUAL FUND OVER WfllCH I HA VE NO CONTROL AND SIMPLY REPLACED SOME OF THE METI.JFE ASSETS US'ICD IN THE 2003 REPORT.

(2) THE ASSETS IN THE IRA ADMINISTERED BY ARGENT WERE All LIQUIDATED AND \VERE ALSO IN WJDEL Y DIVERSE MUTUAL FUNDS. THE ASSETS WITH ONE ASTERJSK (")ARE IN THE METLIFE IRA; THE ASSETS WJTil TWO •• WERE IN TilE ARGENT IRA.

(J) THE ASSETS DESIGNATED WITH THREE ASTERISKS(' ..) ARE THOSE OWNED BY

Page 8: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

Dare of R ep0r1

DESIGN A

........ ..

6/312005

NamcofPemiaR<po«ingFlNANClAL DISCLOSURE REPORT

Duv;:il, Suinv.·ood R

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS

(I) THE ASSETS LISlCD IN SECTION VII T ED WITH A METUFE PREFIX ARE IN A WIDELY DIVERS MUTUAL FUND OVER WHICH I HA VE NO CONTROL AND SIMPLY REPLACE SOME OF THE ASSETS USlCD IN THE 2003 REPORT. THE ASSETS THAT WERE

ADMINISTERED BY THE ARGENT TRUST IN A SEP ARA 1C IRA, ALSO A WIDELY DIVERSE MUTUAL FUND, WERE UQUIDATED.

(2) THE METUFE IRA ASSETS ARE DESIGNATED DY ONE ASTERICK ('),AND THE ASSETS FORMERLY ADMINSTERED BY ARGENT

TRUST ARE DESIGN.,TED BY TWO ASTERJCKS ( ..).

(3) THE ASSETS DESIDNAlCD WITH THREE ASTERISKS('") REPRESENT ASSETS OWNED BY

Page 9: A1al 0 l'' · 2019-07-26 · E AND ryrE 1213104 i\1etLife iltF1xed income from vested pension plan Harold J. Anderson Lease Acquisition. AOC 22,80 4,576 r (SOURCE ANP YPE I. 113104

Date o( Rc pon

___ _ &u f I duJf ?I

•. FlNANClAL DlSCLOSURE REPORT NameofPcnonRc,,orting

OuYal, Stanwood R 61312005

IX. CERTJFICATION.

1 cenify that all infonnation given above (including infonnation pertaining 10 my spouse and minor or dependenl childien, if any) is accura1e, true, and complete 10 the bes I ofmy knowledge and belief, and that any information nol reported was withheld because it met applicable statutory provisions permitting non-disclosure.

J further certify that earned income from outside employment and bonoraria and the acceptance ofgifts which have been reponed are in complia11ce with the provisions of 5 U.S.C. § 501 et. seq., 5 U.S.C. § 7353, and Judicial Conference regulations.

Signarure Da1e -

NOTE: ANY INDIVIDUAL WH WINGLY AND WILFULLY FALSIFIBS ORFAlLS TO FILE THIS REPORT MAY

BE SUBJECT TO CNILAND CRJMJNAL SANCTIONS (5 U.S.C. app. § 104)

FILING INSTRUCTIONS

Mail signed original and 3 additional copies to:

Committee on Financial Disclosure

Administrative Office ofthe United S1ates Courts

Suite 2-301 One Columbus Circle, N.E.

Washington, D.C. 20544