Professional Documents
Culture Documents
1/2011
Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111)
Nomination, [] Initial
fib. [] Amended Report 7. Chambers or Office Address 8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable laws and regulations. Reviewing Officer Date
774 UoS. Courthouse 316 Noah R0be~ Street St. PauI, MN55101
IMPORTANT NOTES: The instractions accompanying this form mast be followed. Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.
D
I. 2. 3. 4. 5.
NAME OF ORGANIZATION/ENTITY
Minnesota Women Lawyers
II. AGREEMENTS. me, ortlng individual only; seepp. 14-16 of filing instructions.)
NONE (No reportable agreements.)
DATE
1.05/01/00 2. 3.
Nelson, Susan R.
III. NON-INVESTMENT INCOME. (Reporting individual and spouse; seepp. 17-24 of:ling instructions.)
A. Filers Non-Investment Income ~] NONE (No reportable non-investment income.)
DATE SOURCE AND TYPE
2. 3. 4.
B. Spouses l~lon-Investment Income - if you were married during any portion of the reporting year, complete this section.
(Dollar amount not required except for honoraria.)
D
I. 2010 2. 3. 4.
DATE
DATES
LOCATION
PURPOSE
V. GIFTS. anctodes those to spouse and dependent children; see pp. 28-31 of filing instructions.)
NONE (No reportable gifts.) SOURCE
1. 2. 3. 4. 5.
DESCRIPTION
VALUE
VI. LIABILITIES. ancludes those olspouse a.d dependent children; see pp. 32-33 of fillng instructions.)
~-~ NONE (No reportable liabilities.) CREDITOR
1. 2. 3. 4. 5. Chase Credit Card
DESCRIPTION
VALUECODE J
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; seepp. 34-60 of filing instructions.)
l"-] NO[NE (No reportable income, assets, or transactions.)
A. Description of Assets (including trust assets) Place "(X)" after each asset exempt from prior disclosure B. Income during reporting period (1) Amount Code l (A-H) (2) Type (e.g., div., rent, or int.) C. Gross value at end of reporting period (1) (2) Value Value Code 2 Method (J-P) Code 3 (Q-W) D. Transactions during reporttng period (1) Type (e.g., buy, sell, redemption) (2) Date mm/dd/yy (3) (4) Gain Value Code 2 Code l (J-P) I (A-H) (5) Identity of buyer/seller (if private transaction)
UBS IRA. #1- Wells Fargo Diversified Capital Builders Fund UBS IRA. #2 - Wells Fargo Diversified Capital Builders Fund UBS Money Market Thor Industries Stock - Common Evergreen Equity Tr Bal. Fund (now Wells Fargo) First American Tech. Fund (now Nuveen Mid-Cap SelectFund) UGTMA Acct. #2 -U.S. COUPON TREASURY STRIPS (A) UGTMA Acct.#2- FIRST AM. PRIME OBLIGS FD A (now American) Leonard Street and Deinard 401K Robins, Kaplan, Miller & Ciresi 401K
B B A A E A B B G F
Dividend Dividend Interest Dividend Dividend Dividend Interest Dividend Interest Interest Interest Interest
K K J J N J
T T T
T T Redeemed 05/15/10
K PI N J J
T T
Private Bank Minnesota Checking Account A Private Bank Minnesota Checking Account A
17.
1. Income Gain Codes: (See Columns B I and D4) 2. Value Codes (See Columns C I and D3) 3. Value Method Codes (See Column C2)
A =$1,000 or less F =$50,001 - $I00,000 J =$15,000 or less N =$250,00I - $500,000 P3 -$25,000,001 - $50,000,000 Q =Appraisal U =Book Value
B =$1,001 - $2,500 G =$100,001 - $1,000,000 K =$15,001 - $ 50,000 O =$500.001 - $1,000,000 R =Cost (Real Estate O~ly) V =Other
C =$2,501 - $5,000 HI -$1,000,001 - $5,000,000 L =$50,001 - $100,000 PI =$1,000,001 - $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
1 certify that all 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.
Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544
Rev. 1/2011
Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. 101-111)
5b. [] Amended Report 7. Chambers or Office Address 8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in eompliance with applicable laws and regulations. Reviewing Officer Date
774 U.S. Courthouse 316 North Robert Street St. Paul, MN 55101
IMPORTANT NOTES: The instructions accompanying this.form must be followetL Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.
POSITION
1. 2. 3. 4. 5. Director (Advisory Board)
NAME OF ORGANIZATION/ENTITY
Minnesota Women Lawyers
DATE
1.05/01/00 2. 3.
Nelson, Susan R. A
2. 3. 4.
B, Spouses Non-Investment Income - If you were married during anyportion of the reporting year, complete this section.
(Dollar amount not required except for honoraria.)
D
i. 2010 2. 3. 4.
DATE
DATES
LOCATION
PURPOSE
V. GIFTS. a.,.t.des ,hose ,o spouse an~ depen~e.t children; see pp. 28-31 of filing instructions.)
NONE (No reportable gifts.) SOURCE
1. 2. 3. 4. 5.
DESCRIPTION
VALUE
VI. LIABILITIES. a.ci.des those o/spouse ~.d ~epe.dent children; see pp. 32-33 of filing instructions.)
~
1. 2. 3. 4. 5.
CREDITOR
Chase Credit Card
DESCRIPTION
VALUE CODE J
VII. INVES TMENTS and TRU STS - i.come, val.e, transactions (Includes those of spouse and dependent children; seepp. 34-60 of filing instructions.)
NONE (No reportable income, assets, or transactions.)
A. Description of Assets (including trust assets) Place "(X)" after each assel exempt from prior disclosure B. Income during reporting period (t) (2) Amount Type (e.g., Code t div., rent, (A-H) or int.) C. Gross value at end of reporting period (1) (2) Value Value Code 2 Method (J-P) Code 3 (Q-W) D. Transactions during reporting period (1) Type (e.g., buy, sell, redemption) (2) (3) (4) Date Value Gain mm/dd/yy Code 2 Code l O-P) (A-H)
1.
B B A A E A B B G
F
K K J J N J
T T T
UBS Money Market Thor Industries Stock - Common Evergreen Equity Tr Bal. Fund (now Wells Fargo) First Araefcan Tech. Fund (now Nuveen Mid-Cap SelectFund) UGTMA Acct. #2 -U.S. COUPON TREASURY STRIPS (A) UGTMA Acct.#2- FIRST AM. PRIME OBLIGS FD A (now American) Leonard Street and Deinard 401K
Robins, Kaplan, Miller & Ciresi 401K
T T Redeemed 05/15/10 K
K P1
N
T T
11.
12.
Interest
Interest
J
J
I. Income Gain Codes: (See Column s B 1 and D4) 2. Value Codes (See Columns C I and D3) 3. Value Method Codes (See Column C2)
A =$1,000 or Jess F -$50,001 o $ 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 -$100,001 - $1,000,000 K =$15,001 - $50,000 O =$500,001 - $I ,000,000 R =Cost (Real Estate Only) V =Other
C =$2,501 - $5,000 H 1 =$1,000,001 - $5,000,000 L =$50,001 - $ 100,000 P1 =$1,000,001 - $5,000,000 P4 =More than $50,000,000 S =Assessment W =Estimated
D=$5,001- $15,000 H2 =M0~ethan $5,000,000 M=$100,001- $250,000 P2 =$5,000,001 - $25,000,000 T =Cash Market
E =$15,001- $50,000
! certify that all 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. 1 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)
Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544