FINANCIAL DISCLOSURE REPORT Reorl Required by e AO JO Rev ...€¦ · POSITION NE OF...

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POSITION NA OF ORGAIZATION/ENTITY PATIES A TERS C Reprl Required by /he £/hies FINANCIAL DISCLOSURE REPORT AO JO in Goverment Act of1978 Rev. 112008 FOR CAENDAR YEAR 2007 (5 u.s.c. ap. §§ 101-111) 1. Pern Repr (last name, ft, midle initial) Gex II, Walter J 2. Cnnr or Organizaton USD/MSSD 3. Date of Reprt 05/13/208 4. Tt (Acle II juge in ave o sr st; msate juges inice fl- or p-time) United States Senior Distict Jue Sa. Rert Typ (ch aproria t) D Nomon Dt D Itl [ Annul D Fil 6. Reprting Period 01/01/207 to 12/31/2007 S. D Am Re 7. Chab o Of Addres 2012 15t St. Suite 572 Gulfort, MS 39501 8. O te bub of th infrmaton cnt in thb Reprt and any motions prtining thereto, it is, in my opinion, in cmpliance wt apcable law• and rlatns. Reviewin Ofer Date IMPORT ANT NOTE: The ituons accomnyi tfofl l b folw COl Rlp, cekg t NONE box for each parl where yu have n reor iforn Sign on lpge I. POSITIONS. (Re ilf" o; se p '13 iffJg it1cn) [ NONE (o reortable positions. 1. 2. 3. 4. 5. II. AGREEMENTS. (ep Uua onl; se p 14-16 tf fg ilin) [ NONE (o reorable agreements. : r ( m - c: r 0 I. 2. 3.

Transcript of FINANCIAL DISCLOSURE REPORT Reorl Required by e AO JO Rev ...€¦ · POSITION NE OF...

Page 1: FINANCIAL DISCLOSURE REPORT Reorl Required by e AO JO Rev ...€¦ · POSITION NE OF ORGNIZATION/ENTITY PRTIES D TEMS ) FINANCIAL DISCLOSURE REPORT . Reorl Required by / h. e £/hies.

POSITION NAME OF ORGANIZATION/ENTITY

PARTIES AND TERMS

CJ')

Reporl Required by /he £/hiesFINANCIAL DISCLOSURE REPORT AO JO in Government Act of 1978 Rev. 112008 FOR CALENDAR YEAR 2007 (5 u.s.c. app. §§ 101-111)

1. Person Reporting (last name, first, middle initial)

Gex III, Walter J

2. Cnnrt or Organization

USDC/MSSD

3. Date of Report

05/13/2008

4. Title (Article III judges indicate active or senior status; magistrate judges indicate full- or part-time)

United States Senior District Judge

Sa. Report Type (check appropriate type)

D Nomination, Date

D Initial [Z] Annual D Final

6. Reporting Period

01/01/2007

to

12/31/2007 Sb. D Amended Report

7. Chamben or Offire Address

2012 15th St. Suite 572 Gulfport, MS 39501

8. On the bub of the information contained in thb Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable law• and regulations.

Reviewing Offker Date

IMPORT ANT NOTES: The instructions accompanying thisfof'lll llUISI be followed. COlltplete Rll parts, checking the NONE box for each parl where you have no reportable information. Sign on last page.

I. POSITIONS. (Reporting illllffld"41 only; see pp. '1-13 iJffJ/ing iltstr11cfions.)

[ZJ NONE (No reportable positions.)

1.

2.

3.

4.

5.

II. AGREEMENTS. (Report;ng UulivUlual only; see pp. 14-16 t!f fiJUtg iltStnlctions.)

[ZJ NONE (No reportable agreements.)

::u rn () m -

ci::::' rn 0I.

2.

3.

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SOURCE AND IYPE

SOURCE

SQURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED

3.

4.

Name of Person Reporting Date of Report FINANCIAL DISCLOSURE REPORT

Page 2of11 Gex III, Walter J 05/13/2008

III. N 0 N-INVESTMENT INC 0 ME. (Reporting ;,,,m,;Jua} <UUi spollM!; see pp. 17-14 of filing instructions.)

A. Filer's Non-Investment Income

[Z] NONE (No reportable non-investment income.)

INCOME (yours, not spouse's)

1.

2.

4.

B. Spouse's Non-Investment Income Ifyo11 were married daring any portion oftlu reporting year, complete this section. -

(Dof/ar amount not required except for honoraria.)

0 NONE (No reportable non-investment income.)

AND TYPE

1. 2007 United States Courts

2.

3.

4.

IV. REIMBURSEMENTS -trtursportafion, lodging, food, entertainment.

(Includes those to spouse and dependent children; see pp. 25-27 of filing instructions.)

[Z] NONE (No reportable reimbursements.)

I.

2.

3.

5.

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SOURCE DESCRIPTION

CREDITOR DESCRIPTION VALUE

3.

3.

Date of Report Name of Person Reporting FINANCIAL DISCLOSURE REPORT

Page 3of11 05/13/2008Gex III, Walter J

V. GIFTS. (lncliuks thOSL to spouse and dependent cllildren; supp. .28-31 of filing instrlldions.)

[ZJ NONE (No reportable gifts.)

VALUE

I.

2.

4.

5.

VI. LIABILITIES. (lncbuks those of spo11St! ans/ dependent children; see pp. 3.2-33 of filing instruc6ons.)

[ZJ NONE (No reportable liabilities.)

CODE

1.

2.

4.

5.

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I

interest

0

interest

(l)

(A-H)

Date of Report Name of Person ReportingFINANCIAL DISCLOSURE REPORT

Page 4of11 Gex Ill, Walter J 05/13/2008

VII. INVESTMENTS and TRUSTS -wome. w1111e, wlfSllcrions (lncJIUles those ofspoMSeiUUI depemknichildren; see pp. J4-6Qoffiling instructiom.J

D 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

(l) (3)(2) (2)(1) (4) (5)(2) Date Value GainValue Value Type (e.g.,Place "(X)" after each asset Amount Type (e.g., Identity of

Code I Month- Code2 Code Ibuy, sell, Method buyer/sellerdiv., rent, Code2exempt from prior disclosure (A-H) redemption) DayCode3or int.) (J-P)(J-P) (if private

(Q-W) transaction)

1. Parcel 7, Jackson Co., MS 9.1435% of 1/5 interest

None K w

2. Pared 8, Jackson Co., MS 9.1435% of 1/5 interest

None K w

3. Paracel 4, Hancock Co., MS 33.33% interest None K w

4. Parcel 5, Hancock Co., MS 33.33 % interest None K w

5. Parcel 6, Hancock Co., MS 33.33% interest None K w

6. Parcel 7, Hancock Co., MS 33.33% interest None K w

7. Parcel 8, Hancock Co., MS 33.33% interest None K w

8. Parcel 9, Hancock Co., MS 33.33% interest None K w

9. Parcel 10, Hancock Co., MS 33.33 % interest

None K w

10. Parcel 12, Hancock Co., MS 33.33% interest

A Rent K w

11. Parcel 13, Hancock Co., MS 33.33% A Rent K w

12. Parcel 14, Hancock Co., MS 33.33% interest

A Rent K w

13. Parcel 15, Hancock Co., MS 33.33% interest

None K w

14. Parcel 16, Hancock Co., MS 33.33% None K w

15. Parcel 17, Hancock Co., MS 25% interest None K w

16. Parcel 18, Hancock Co.,, MS 25% interest None K w

17. Adams Co., MS .292500/o mineral interest A Royalty J w

J. Income Gain Codes: A=$1,000 or less B=$1,001 -$2,500 c =12,501 - $5,000 D =$5,001 -$15,000 E =$15,001 -$50,000

(See Columns B 1 and D4) F=150,001 - $100,000 G =$100,001 -Sl,000,000 HJ =$1,000,001 - $5,000,000 H2 =More than $5,000,000

2. Value Codes J =$15,000 or less K =115,001 -$50,000 L=150,001 -$100,000 M =$100,001 -$250,000

(See Columns Cl and D3) N =$250,001 -$500,000 0=$500,001-$1,000,000 Pl =;i.) ,000,001 - $5,000,000 P2 =$5,000,001 - $25,000,000

P3 =125,000,001 -$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

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B.

(A-H) (J-P)

Date of Report Name of Person Reporting FINANCIAL DISCLOSURE REPORT

Page 5of11 05/13/2008Gex Ill, Walter J

VII. INVESTMENTS and TRUSTS - mco-, ,,.,,,,e, fTtlRSMcli<>ns r1ncJl#ks those of spous """dependent children; see PP· 34-60 of filing instrllClions.J

0 NONE (No reportable income, assets, or transactions.)

D.A. c.

Description of Assets

(including trust assets)

Place "(X)" after each asset

exempt from prior disclosure

Income during

reporting period

(I) ( 2)

Amount Type (e.g., Code I div., ren

Gross value at end of

reporting period

(1) (2) Value Value

Code2 Method

Transactions during reporting period

(1) (2) (3) (4) (5)

Type (e.g., Date Value Gain Identity of

huy, sell, Month- Code2 Code I buyer/seller

Dayredemption)or int.) Code3(J-P) (A-H) (if private

transaction)(Q-W)

18. Parcel l, Forrest Co., MS - less than 5% mineral interest

None J w

19. Parcel 2, Forrest Co., MS - less than 5% mineral interest

None J w

20. Parcel 3, Forrest Co., MS - less than 5% mineral interest

None J w

21. Parcel 4, Forrest Co., MS - less than 5% mineral interest

None J w

22. Parcel 1, George Co., MS - less than 5% mineral interest

None J w

23. Parcel 2, George Co., MS - less than 5% mineral interest

None J w

24. Parcel 3, George Co., MS - less than 5% mineral interest

None J w

25. Parcel 4, George Co., MS - less than 5% mineral interest

None J w

26. Parcel 5, George Co., MS - less than 5% mineral interest

None J w

27. Parcel 6, George Co., MS - less than 5% mineral interest

None J w

28. Parcel 7, George Co., MS - less than 5% mineral interest

None J w

29. Parcel 1, Greene Co., MS 9.1435% mineral interest

None J w

30. Parcel 2, Greene Co., MS 9.1435% mineral interest

None J w

31. Parcel 3, Greene Co., MS 9.1435% mineral interest

None J w

32. Parcel 4, Greene Co., MS 9.1435% mineral interest

None J w

33. Parcel I, Hancock Co., MS 25%mineral interest

A Royalty J w

34. Parcel 2, Hancock Co., MS 25% mineral interest

A Royalty J w

I. Income Gain Codes: A =$ J ,000 or less B =$1,001 -$2,500 c =S2,501 - $5,000 D =S5,00J - $15,000 E =$15,001 -$50,000 (See Columns BI and D4) F =S50,001 -$100,000 G =SJ00,001 -$1,000,000 HI =Sl,000,00J • $5,000,000 H2 =More than $5,000,000

2. Value Codes J=$J5,000orless K =$15,001 -$50,000 L =S50,00J - $100,000 M =$100,001 -$250,000 (See Columns Cl and D3) N =S250,00J -$500,000 O=S500,00l-$1,000,000 Pl =Sl,000,001 - $5,000,000 P2 =S5,000,001 -$25,000,000

P3 =S25,000,00 I - $50,000,000 P4 =More than $50,000,000 3. Value Method Codes Q =Appraisal R =Cost (Real Estale Only) T =Cash Market

(See Column C2) U Book Value v =Other W =Estimated S =Assessment

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minera

35.

42.

47.

51.

Date of Report Name of Person Reporting FINANCIAL DISCLOSURE REPORT

Page 6of11 Gu Ill, Walter J 05113/2008

VII. INVESTMENTS and TRUSTS Utcl)llU!, w11..,,, transactU>ns r1ndiu1es tJwse ofspoMSe and dependent children; supp. 34-60 of filing instructWns.J -

0 NONE (No reportable income, assets, or transactions.)

A.

Description of Assets

(including trust assets)

Place "(X)" after each asset

exempt from prior disclosure

Parcel 3, Hancock Co., MS 25% mineral

B. c. D.

Income during Gross value at end of Transactions during reporting period

reporting period reporting period

(1) (2) (1) (2) (1) (2) (3) (4) (5) Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity of Code l div., rent, Code 2 Method buy, sell, Month - Code 2 Code 1 buyer/seller (A-H) or int.) (J-P) Code3 redemption) Day (J-P) (A-H) (ifprivate

(Q-W) transaction)

A wRoyalty J interest

36. Parcel 4, Hancock Co., MS 25% mineral A interest

37. Parcel 5, Hancock Co., MS 25%mineral A interest

38. Parcel 6, Hancock Co., MS 25% mineral A interest

39. Parcel 7, Hancock Co., MS 25% mineral A interest

40. Parcel 8, Hancock Co., MS 25% mineral A interest

41. Parcel 9, Hancock Co., MS 25% mineral A interest

Royalty

Royalty

Royalty

Royalty

Royalty

Royalty

J

J

J

J

J

J

w

w

w

w

w

w

Parcel 10, Hancock Co., MS 25%mineral A Royalty wJ interest

43. Parcel I, Harri.son Co., MS 9.1435% mineral interest

44. Parcel 2, Harrison Co., MS 9.1435% interest

45. Parcel 1, Jackson Co., MS 9.1435% mineral interest

46. Parcel 2, Jackson Co., MS 9.1435% mineral interest

None

None

None

None

J

J

J

J

w

w

w

w

Parcel 3, Jackson Co., MS 9.1435% mineral None J w interest

48. Parcel 4, Jackson Co., MS 9.1435% mineral interest

49. Parcel 5, Jackson Co., MS 9.1435% mineral interest

50. Parcel 6, Jackson Co., MS 9.1435% mineral interest

None

None

None

J

J

J

w

w

w

Parcel 7, Jackson Co., MS 9.1435% mineral None wJ interest

L lncomc Gain Codes: A =$ l ,000 or less B =$ ! ,OOl -$2,500 c 2,501 - $5,000 D 5,001 - $15,000 E =$15,001 -$50,000

(See Columns Bl and D4) F 50,001 - $100,000 G=$100,00l -$1,000,000 Hl =$1,000.001 -$5,000,000 H2 =More than $5,000,000

2. Value Codes J =$15,000 or less K=$l5,001 -$50,000 L 50,001 - $100,000 M 100,001 - $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 5,000,00 l - $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=Otbcr W Estimated

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Page 7of11 Gex III, Walter J 05/13/2008

VII. INVESTMENTS and TRUSTS -mco-, l'tllw, INmsacliDns (lncJlllles those of spouse""" dependen1chiJt1ren; see pp. 34-60 of filing insm1ctions.J

D NONE (No reportable income, assets, or transactions.)

Description of Assets

B. D.c. Transactions during reporting period Income during Gross value at end of

(including trust assets) reporting period reporting period

(3)(2) (!) (2)(I) (I) (2) (5) Amount Value ValueType (e.g.,Place "(X)" after each asset Code l Methoddiv., rent, Code 2exempt from prior disclosure (A-H) or int.) Code 3(J-P)

(Q-W)

Type (e.g., buy, sell,

redemption)

Date

Month-

Day

Value Gain Identity of

Code 2 Code I buyer/seller

(A-H) (if private

transaction)

(J-P)

52. Parcel 8, Jackson Co., MS 9.1435% mineral None J w interest

53. Parcel 9, Jackson Co., MS 9.1435% mineral None J w interest

54. Parcel 10, Jackson Co., MS 9.1435% None J w mineral interest

55. Parcel 11, Jackson Co., MS 9.1435% None J w mineral interest

56. Parcel 12, Jackson Co., MS 9.1435% None J w mineral interest

57. Parcel 13, Jackson Co., MS 9.1435% None J w mineral interest

58. Parcel 14, Jackson Co., MS 9.1435% None J w mineral interest

59. Parcel 15, Jackson Co., MS 9.1435% None J w mineral interest

60. Parcel 16, Jackson Co., MS 9.1435% None J w mineral interest

61. Parcel l, Lamar Co., MS 9.1435% mineral None J w interest

62. Parcel 2, Lamar Co., MS 9.1435% mineral None J w interest

63. Parcel 3, Lamar Co., MS 9.1435% mineral None J w interest

64. Parcel 4, Lamar Co., MS 9.1435% mineral None J w interest

65. Marion Co., MS 9.1435% mineral interest A Rent J w

66. Parcel 1, Pearl River Co., MS 9 .1435% None J w mineral interest

67. Parcel 2, Pearl River Co., MS 9.1435% None J w mineral interest

68. Parcel 3, Pearl River Co., MS 9.1435% None J w mineral interest

----

l. Income Gain Codes: A 1,000 or less B =$1,001 - $2,500 C 2,50 I - $5,000 D =$5,001 - $15,000 E =$15,001 - $50,000

(Sec Columns Bl and D4) F =$50,001 -$100,000 G 100,001 -$1,000,000 HJ =SI,000,001 · S5,000,000 H2 =More than $5,000,000

2. Value Codes J 15,000 or less K l5,00l -$50,000 L=$50,001-$100,000 M =Sl00,001 - $250,000

(Sec 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 =Assessment T =Cash Market

(See Column C2) U =Book Value V=Other W=Estimated

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(2) (2) (2) (5)

Date of Report Name of Person Reporting FINANCIAL DISCLOSURE REPORT

Page 8ofl1 05/13/2008Gex III, Walter J

VII. INVESTMENTS and TRUSTS - incm,,,,, Wllue, tronsacti.ms (lndlldes those of spouse and .tepemknt children; see PP· 34-Mi offuinc instructions.)

NONE (No reportable income, assets, or transactions.) D A. B. D.

Transactions during reporting period Income during Gross value at end of Description of Assets

reporting period reporting period (including trust assets)

(1) (I) (I) Value

Code 2

(J-P)

(;) "'GainAmount Value Value Type (e.g.,Type (e.g., Place "(X)" after each asset

Code I Date

Month-

Identity o f

Method buy, sell, Code 2div., rent, Code I buyer/sell er exempt from prior disclosure (A-H) Day (A-H)redemption)Code 3or int) (J-P) (if private

(Q-W) transaction)

69. Parcel 1, Perry Co., MS 9.1435% mineral interest

70. Parcel 2, Perry Co., MS 9.1435% mineral interest

None

None

J

J

w

w

71. Parcel 3, Perry Co., MS 9.1435% mineral interest

None J w

72. Parcel 4, Perry Co., MS 9.1435% mineral interest

None J w

73. Parcel 5, Perry Co., MS 9.1435% mineral interest

None J w

74. Parcel I, Stone Co., MS 9.1435% mineral interest

None J w

75. Parcel 2, Stone Co., MS 9.1435% mineral interest

None J w

76. Parcel 3, Stone Co., MS 9.1435% mineral interest

None J w

77. Parcel 4, Stone Co., MS 9.1435% mineral interest

None J w

78. Parcel 5, Stone Co., MS 9.1435% mineral interest

None J w

79. Parcel 6, Stone Co., MS 9.1435% mineral interest

None J w

80. Parcel 7, Stone Co., MS 9.1435% mineral interest

None J w

81. MCI Wotldcom (formerly Sk.ytel) (IRA) None J T

82. Long leaf Partners Fund (IRA) D Distribution K T

83. Longleaf Partners Fund (IRA) None K T

84. Superconductor Technologies (IRA) None J T

85. Shady Acres Partnership None J w

1. Income Gain Codes; A =$1,000 or less B =SJ,001 -S2,500 c =$2,501 -$5,000 D =$5.001 -$15,000 E =$15,001 -$50,000

(See Columns BI and D4) F=$50,001-$100,000 G =$100,001 -$1,000,000 HI =$1,000,001 -$5,000,000 H2 =More than $5,000.000

2. Value Codes J =$15,000 or less K=$J5,001 -$50,000 L =$50.001 -$100,000 M =$100,001 -$250,000

(See Columns Cl and DJ) N =$250,001 -$500,000 0 =$500,001 -s l ,000,000 Pl =$1,!00,001-$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=CashMarl<el

(See Column C2) U =Book Value V =-Other W=Estimatcd

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Date of Report Name of Person Reporting FINANCIAL DISCLOSURE REPORT

Page 9of11 Gex III, Walter J 05/13/2008

VII. INVESTMENTS and TRUSTS - ina»fu, ...w.e, tronSRC&ms (lndutiesthoseofspousetuU/depenJJentchildren;seepp. J4-60offilinginstr1tctwns.J

D 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

(1) (I)(2) (1) (2) (4)(3) (5) Amount Value ValueType (e.g., Place "(X)" after each asset Code I div., rent, Code 2 Method (A-H)

exempt from prior disclosure

or int.) (J-P) C ode3 (Q-W)I

Type (e.g.,

buy, sell,

redemption)

Date

Month-

Day

GainValue Identity of

Code lCode2 buyer/seller

(J-P) (if private

transaction)

(A-H)

86. Gulf Coast Partners, LTD None L w

87. Whitney Nat'! Bank, Gulfport, MS c Dividend M T

88. Whitney Nat'! Bank, Gulfport, MS A Interest J T

89. Paul Milam Development, Inc. D Dividend J w

90. Rex Land, Inc. None K w

91. Tri-C-Ounty Hunting & Fishing Club None M w

92. Adam None J T

93. Hancock Bank Holding Co. B Dividend L T

94. GBC Lands, LLC (Hancock Co. MS) D Rent M w

l. lncome Gain Codes: A oil ,000 or less B =$1,001 - $2,500 C =$2,50 I - $5,000 D =$5,001 -$15,000 E=$15,00! -$50,000

(See Columns BI and D4) F oo$50,00! - $100,000 G !00,001-$1,000,000 HJ =$1,000,001 - $5,000,000 H2 =More than $5,000,000

2. Value Codes J oi15,000 orless K l5,00I -$50,000 L =$50,001 - $100,000 M 100,001 - $250,000

(See Columns CJ and 03) N =$250,001 - '·00,000 0 =$500,001 - $1,000,000 Pl =Sl,000,001 - $5,000,000 P2 =S5,000,00! - $25,000,000

P3 oi25,000,00I -$50,000,000 P4 =More than $50,000,000

3. Value Me!bod Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T =Cash Market

(See Column C2) U =Book Value V=Otber W =Estimated

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FINANCIAL DISCLOSURE REPORT Name of Person Rep<>rtlng Date of Report

Page 10of11 Gex Ill, Walter J 05/13/2008

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS. (JnJicateparto[Report.)

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Name of Penwn Reporting FINANCIAL DISCLOSURE REPORT

Page 11of11 Gex III, Walter J

Date of Report

05/13/2008

IX. CERTIFICATION.

I certify that all information giYen 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 F AILS 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