You are on page 1of 6

t

Roy. 1/2010

no 0

FINANCIAL DISCLOSURE REPORT


FOR CALENDAR YEAR 2009
.2. Court or Organization

Report Requiredby the Ethics


(s u.s.c. ~pp. # IOl-i~0
3. Date of Report in Government ,let of I978

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

4. Title (,aa-iicle 111 judge~ indicate active or senior statu~; magistrate judges indicate full- or part-time)

" 15 R tiT ype (crmc appropriate type/ k i a. epo

6. Reporting Period

5b. ~ Amended Repo~ 7. Chambers or Offic~ Address ~} -~ C O. C ~ ~ 0 ~ ~ ~ 8. On the basis of the information contained in this Repo~ and any modifications pertaining thereto, it is. in my opinion, i .... plianc with applicable izws and rt~lations.

IMPORTANT NOTES: T~e instructions accompanying this form must be followe~ Complete all parts,
checking the NONE box for each part where you have no reportab& information. Sign on last page,

I. POSITIONS. (Reporting individual only; seepp. 9-13 of Jiling i .....


[~] NONE (No reportable positions.) POSITION

ctions.)

NAME OF ORGANIZAT!ON!ENTITY

II. AGREEMENTS. ~R,po,ti.~ ~.d~.i~a~ o.e; ,ee ~,. ,-~ ,w~.~ ~ ........
~ NONE (No reportable agreements.) DATE

~o,,,.)
~~ PARTIES AND TERMS -

2.

Kavanaugh, Brett M.

FINANCIAL DISCLOSURE REPORT

n~.,~ of P ....Reporting

Da, of Report

Ill. NON-INVESTMENT IN COME. Repoeti,g i,d,Zoai ,,d ,p ....; ~ee ~. ~-~4 oyfai,g ~ ......,io~.)
A. Filers Non-Investment Income

NONE (No reportable non-investment income.)

DATE

SOURCE AND TYPE

INCOME
(yours, not spouses}

2.

B. Spouses Non-lnvestm ent ] ncome - tf yoa were married during any portion of the reporting year, complete this sectio~
(Dollar amount not required ~xcept for honoraria.)

1~] NONE (No reportable non-investment income.)

DATE

SOURCE AND TYPE

IV. REIMBURSEMENTS --,....~o.,.,io., Igdging, faod, entcrmi .....


(Includes those to spouse ond dependent children: see pp. 25 27 ef f!l~ng inst~wtions.)

NONE (No reportable reimbursements.) SOURCE DATE~ LOCATION PU~OSE ITEMS PAID OR PROVIDED

2.

4 5.

FINANCIAL DISCLOSURE REPORT

S~m, of Person Reporting

Date of Report

V. GIFTS. a,~t,~ ,~os, ~o ,,o,~, ,,a depenaent children; see pp. 2t-31 o/filing inseruction~)
~ NONE ~o reportable EOURCE
1

DESCRIPTION

VALUE

2
3. 4 5.

VI. LIABILITIES. a, ct,d~, those o/~~o,,e ,,d de, o,~ ~ita,~n: ~ ,p. 3Z.33 o/~i~g i ...... ~o..,.;
~ NONE (No reportable liabilities.) C~DITOR DESC~PTION VALUE CODE

FINANCIAL DISCLOSURE REPO RT


Page 4 of 6 VII. INVEST~NTS and TRUSTS -~ ........

N ....

f Person Reporting

Date of R~port

~"~AN}!~U~Prs~"~TT f~"
z.,, transactions (Includes those qsp ......
C. Gross value at end of reposing peri~

d depen~nt children; see pp. 34-60of]ilinginstractions.)

NONE (No reportable income, assets, or transactiom.)


A. Description of Assets (including lpa~t assem) B. income dunng reposing peri~ D. ~ran~clions during r~o~ing pe~od ~ (4) from prio~ disclosure .............. ~

Code ] div.. ~A-H) ~ orint,) ~

,--,

~ Method Code 3 (Q-W)

reOemption)

Code 2 C~e (J-P) ] (A.H) ]

{ifprivage traus~cl~on)

3.

10 II

15

16
~7

FINANCIAL DISCLOSURE REPORT Page 5 of 6

N~,~ of P~rso. R~por~g

VIII. ADDITIONAL INFORMATION OR EXPLANATIONS,

FINANCIAL DISCLOSURE REPORT

~me of Person Reporting

Date of Report

IX. CERTIFICATION.
1 certify that all information given above (including information pertaining to my spouse and minor or dependent children, if any) is accurate, true, and complcte to the best of n!y 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 arc 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 ANDWILFULLY FALSIFIES OR FALLS 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

You might also like