FINANCIAL DISCLOSURE REPORT FOR CALENDAR YEAR 2010 Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app. §§ 101-111) I. Person Reporting (last name, first, middle initial) MONTGOMERY, ANN D. 4. Title (Article 111 judges indicate active or senior status; magistrate judges indicate full- or part-time) ARTICLE Ili JUDGE - ACTIVE 7. Chambers or Office Address 13W U.S. COURTHOUSE 300 SOUTH FOURTH STREET MINNEAPOLIS, MN 55415 2. Court or Organization U.S. DISTRICT COUR T - MN 5a. Report Type (check appropriate type) ] Nomination, Date [] Initial [] Final 5b. [] Amended Report 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 3. Date of Report 05/03/2011 6. Reporting Period 01/01/2010 to 12/31/2010 IMPORTANT NOTES: The instructions accompanying this form must be followed. Complete all parts, checking the NONE box for each part where you have no reportable information. Sign on last page. I. PO SITI O N S. (Reporting individual only; see pp. 9 -13 of filing instructions.) ~] NONE (No reportable positions.) POSITION 2. 3. 4. 5. NAME OF ORGANIZATION/ENTITY I I . AG REEM ENTS. (Rc~,orting inaividuat only; sce ~,p. 14-16 of filing instructions.) ~] NONE (No reportable agreements.) DATE PA RTIES A ND TERMS Mont. omerv, Ann D.
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Ann D Montgomery Financial Disclosure Report for 2010
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8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
I l l . N O N - I N V E S T M E N T I N C O M E . (Reporting individual and spouse; seepp. 17-24 of filing instructions.)
A. Filer’ s Non-Investm ent Incom e
~ (No reportable non-investment income.)ONE
DATE SOURCE AND TYPE
2.
3.
4.
INCOME
( y o u r s , n o t s p o u s e ’ s )
B . S p o u s e ’ s N o n - l n v e s t m e n t I n c o m e - i f you were married during an yport ion of the report ing year, complete this sect ion.
( D o l l a r a m o u n t n o t r e q u i r e d e x c e p t f o r h o n o r a r i a .)
[~ N O N E ( N o rep o r ta b le no n - inves tmen t inco me. )
D A T E
1. 2010
2.
3.
4.
S O U R C E A N D T Y P E
A r t h u r , C h a p m a n , K e t t e r in g , S m e t a k & P i k a l a L a w F i r m
I V . R E I M B U R S E M E N T S - transportation, lodging, food, entertainment.
(Includes those to spouse and dependent children," see pp. 25-27 of filing instructions.)
[~ N O N E (No reportable reimbursements.)
SOURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED
1 . In te rn a tio n a l C rim in a l M arch 1 5 - M arch 21 , A m sh a , T an za n ia IC T R T ra in in g - D ire c t a n d T ra n sp o r ta tio n , lo d g in g , m e a lsT r ib u n a l fo r R w a n d a 2010 C ro ss E xa m
2. T h e A s p e n I n s t i t u t e /R o b in a N o v e m b e r 5 - Qu e e n s to wn , M D The Aspen Inst i tu te Just ice Tr a n s p o r t a t i o n , l o d g i n g , me a l sF o u n d a t i o n N o v e m b e r 7 , 20 1 0 a n d S o c ie ty P ro g ra m
3. A m eric a n C o n fe re n c e N o v e m be r 3 0 - O r l a n d o , F L A C I ’ s 2 1 s t A n n u a l B a d T ra n s p o r t a t i o n , l o d g i n g , m e a l sInstitute D e c e m b e r 1 ,2 0 1 0 Fa i t h L i t ig a t i o n C o n fe re n c e
4.
5.
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
V I I . I N V E S T M E N T S a n d T R U S T S -income, value, transactions (Includes those of spouse and dependent children; see pp. 34-60 of filing instructions.)
N O N E ( N o reportable income, assets, or transactions.)
A. B. C. D.
Descr ipt ion of Asset s I nc ome dur i ng Gross value at end T ran sac t ion s dur i n g r e p o r t i n g p e r i o d
( inc luding t r u s t a s se t s ) r e p o r t i n g p e r i o d o f r e p o r t i n g p e r i o d
(l) (2 ) (1) (2) (l) (2) (3) ] (4) (5 )
Place "(X)" af ier each asse t A m o u n t Type(e.g., Value Value Type(e.g., Date Value I Gain Identityof
exempt from prior disclosure Code I div . , r en t , C o d e 2 M e t h o d b u y , sell, mm/dd/yy Code 2 I Code 1 buyer/sel ler
( A - H ) o r i n t . ) (J-P) C o d e 3 r e d e m p t i o n ) (J P) ( A - H ) ( i f pr i vat e
( Q - W ) t r ansac t i on)
T
T
U
S
1 . US Bancorp A I n t e r e s t J
2. Nortech System - Comm on Stock A Dividend J
3. Minn esota State Judge Retirem ent Plan None K
4. I\4 Interest in farm land in M eeker County, A Rent L
5. Neurogen Corp. H W P - Comm on Stock None Sold 06/01/I 0 J A
6. Lincoln Life Variable Ann uity Fund None Sold 03/10/10 L A
7. Tmns Amer ica Annui ty None L T Buy 03110/10 L
8. Alliance Bernstein Balanced Wealth A Dividend Sold 02116110 LS t r a t e g i e s
9. Pimc o Total Return B Dividend K T Buy 02/16110 K
1 0 . Prudential Natural Resource A Dividend K T B uy 02116110 K
1 1 . Blackrock Global Allocation A Dividend K T B uy 02116/10 K
1 2 . First Eagle A Dividend K T Buy 02/16110 K
1 3 . IvyAsset Strategy A Dividend K T Buy 02/16/10 K
1 4 . Black rock Global Allocation - IRA A Dividend K T Sold 02/16/10 M D(part)
1 5 . Prudential Natural Resource - IRA A Dividend K T B uy 02116/10 K
1 6 . lvyAsset Stm gegy- IRA A Dividend K T B uy 02/16/10 K
1 7 . First Eagle- IRA A Dividend K T Bu y 02/16/10 K
I. I n c o m e G a in C o d e s : A =$1, 000 or l ess B =$ 1 ,001 - $ 2,500 C = $ 2,501 - $ 5,000 D = $ 5,001 - $ 15,000
(See C o l u m n s B 1 and D4) F =$ 50,001 - $100,000 G -$100,001 - $1,000,000 H I = $1,000,001 - $5,000,000 H2 =M ore t han $5 , 000 , 000
2. Va lue Code s J =$15 , 000 or l ess K =$15,001 - $50,000 L -$ 50 ,0 01 - $ I00 .0 00 M =$ 100,001 - $ 250,000
(See Col um ns C 1 and D3) N =$250,001 - $ 500,000 O =$500,001 - $ 1,000,000 P 1 =$1,000,001 - $5,000,000 P2 =$5,000,001 - $25,000,000
P3 =$25.000,001 - $50,000,000 P4 =M or e th a n $50 ,0 0 0 ,00 0
3. Va lue Me th od Code s Q =Appra i sa l R :Cos t (Real Estale Only) S = A s s e s s m e n t T = C a s h Market
(See Col um n C2 ) U = B o o k V a l u e V - O t h c r W =Es t ima tcd
E =$15,0 0 1 - $ 50 ,0 0 0
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
V I I . I N V E S T M E N T S a n d T R U S T S - i n c o m e , v a l u e , t r a n s a c t i o n s ( I n c l u d e s t h o s e o f s p o u 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 . 3 4 - 6 0 o f f i li n g i n s t r u c t i o n s . )
N O N E ( N o reportable income, assets, or transactions.)
D e 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( in c lu d in g tru s t a s se ts ) r e p o r t in g p e r io d
( ! ) (2)
Place "(X)" after each asset A m o u n t Type (e.g.,
exempt from prior disclosure C o d e 1 d i v . , r e n t ,
( A - H ) o r i n t . )
G r o s s v a l u e a t e n do f r e p o r t i n g p e r i o d
(1) (2)
Value Value
C o d e 2 M e th o d
(J-P) C o d e 3
( Q - W )
( l)
Type (e .g. ,
buy, se l l ,
redempt ion)
T r a n sa 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
( 2 ) ( 3 ) ( 4 )
Date Va lu e Ga i n
m m / d d / yy C o d e 2 Code 1
( J - P ) ( A - H )
( 5 )
Identity of ..
buyer/seller
(if private
t r a n s a c t i o n )
18. Pimco-IRA B Dividend K T B uy 02/16/10 K
l , Income Ga in Code s :
( S e e C o l u m n s B I a n d D 4 )
2 . Va lue Code s
( S e e C o l u m n s C I a n d D 3 )
3.Va lue Me th od Code s
( S e e C o l u m n C 2 )
A=$1,000 o r lcss
F =$50, 001 - $ 100, 000
J =$15,0 0 0 or l c s s
N = $250 ,0 0 1- $50 0 ,0 0 0
P3 =$25,000,001 -$50,000,000
Q=Appr a i s a l
U = B o o k V a l u c
B =$1 ,0 0 1- $2 ,50 0
G = $I0 0 ,0 0 1- $1 ,0 0 0 ,0 0 0
K =$15,0 0 1- $ 50 ,0 0 0
O=$50 0 ,0 0 1 - $1 ,0 0 0 ,0 0 0
R =Cos t ( Re a l Es t a t e Only)
V = O t h e r
C =$2,501- $5 ,000
HI =$ 1 ,0 0 0 ,0 0 1- $5,0 0 0 ,0 00
L =$ 50 ,0 0 1- $10 0 ,0 00
PI =$1 ,0 0 0 ,0 0 1- $5,0 0 0 ,0 0 0
P4 =M or e th a n $50 ,0 0 0 ,00 0
S =As s e s s mcnt
W = E s t i m a t c d
D=$5,0 0 1- $15,0 0 0
t t2 =More~an $5 ,000 ,000
M $100,001- $250,000
P2 =$5,000,001- $25,000,000
T = C a s h M a r k c t
E =$15 ,0 0 1 -$50 ,0 0 0
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
I c e r t if y t h a t a ll i n f o r m a t i o n g i v e n a b o v e ( i n c l u d i n g i n f o r m a t i o n p e r t a i n i n g t o m y s p o u s e a n d m i n o r o r d e p e n d e n t c h i l d r e n , i f a n y ) i sa c c u r a t e , tr u e , a n d c o m p l e 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 y i n f o r m a 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 p l i c a b l e s ta t u t o r y
p r o v i s io n s p e r m i tt i n g n o n - d i s c l o s u re .
I f u rt h e r c e r ti f 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 m e 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 ts 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 i a n c e ~ v i t h t h e p ro v i s i o n s o f 5 U . S . C . a p p . § 50 1 e t . s e q ., 5 U . S . C . § 7 353 , a n d Ju d i c i a l C o n fe re n c e r e g u l a t i o n s .
Signatur e: S/ANN D. MONTGOM ERY
N O T E : A N Y I N D IV I D U A L W H O K N O W I N G L Y A N D W I L F U L L Y F A L S IF IE S O R F A I L S T O F I LE T H I S R E P O R T M A Y B E S U B J E C T T O C IV I LA N D C R I M I N A L S A N C T I O N S ( 5 U . S .C . a p p . § 1 0 4 )
Committee on Financial Disclosure
Administrative Office of the United States Courts
Suite 2-301
One Columbus Circle, N.E.
Washington, D.C. 20544
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
1 . Person Reporting (last name, firs t , middle init ial)
M O N T G O M E R Y , A N N D .
4. Tit le (Artic le ! i l judges indicate act ive or sen ior s ta tus ;magis t rate judges indicate fu l l - or p ar t - time)
A R T I C L E I ll J UD G E - A C T I V E
7 . Ch a mb e rs o r Of f ic e Addre s s
1 3 W U. S . COUR T H OUS E3 0 0 S O UT H F O U R T H S T R E E T
M I NNE A P OL I S , M N 554 1 5
2. Co urt o r Org an iza t io n
U.S. DISTRICT COURT * MN
5a . Report Type (check appropria te type)
] Nominat ion , Date
[] Initial [] Annual [] Final
5h. [] Amended Report
8. On the basis of the informat ion conta ined in this Report and anymod if ica t ions perta in ing there to , it i s , in my opin ion , in compliancewith a pp l i c a b le l a ws a nd re gu la t ions .
R e v i e w i n g O f f i c e r D a t e
3. Date of R e p o r t
07 /11/2011
6 . Re p o r t i n g P e r i o d
0 1 / 0 1 / 20 1 0to
12/31/2010
I M P O R T A N T N O T E S : The instructions accompanying this form must be followetL Complete all parts,
checking the NON E box for each part where you have n o reportable information. Sign on iast page.
I . P O S I T I O N S . ( R e p o r t i n g i, dividuul only; seepp. 9-13 of filing instructions.)
~] N O N E ( N o reportable positions.)
PO SI T I O N
2.
3.
4.
5.
NAME OF ORGANIZATION/ENTITY
I I . A G R E E M E N T S . (Reporting individual only; seepp. 14-16 of filing instructions.)
~] N O N E ( N o reportable agreements.)
D A T ~ E PARTIES AND TERMS
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
I l L N O N - I N V E S T M E N T I N C O M E . ( R e p o r t i n g i n d i v id u a l a n d s p o a s c ; s e e p p . 1 7 - 2 4 o I ~ l l n g instructions.)
A. Filer’s Non-Investm ent Incom e
~ (No reportable non-investment income.)O N E
DATE SOURCE AND TYPE
2.
3.
4.
I N C O M E( y o u r s , n o t s p o u s e ’ s )
B . S p o u s e ’ s N o n - I n v es t m e n t I n co m e - if you were married during any portion of the reporting year, complete this section.
(D ollar amount not required except for honoraria.)
N O N E ( N o reportable non-investment income.)
1.2010
2.
3.
4.
DATE SOURCE AND TYPE
A r t hu r , C ha p ma n , K e t t e ri n g , S me t a k & P i k a l a L a w F i r m
I V . R E I M B U R S E M E N T S - transportation, lodging, food, entertainment.
(Includes those to spouse and dependent children; see pp. 25-27 of filing instructions.)
~ (No reportable reimbursements.)O N E
SOURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED
1 . I n t e ma t i 0 n a l C r i mi n a l M a rc h 1 5 - M ar ch 21 , A m s h a, Ta n za n ia IC T R T r a in in g - D i r e ct a n d T r a n sp o r ta t io n , lo d g in g , m e a l sT r i bu n a l f o r Rw a n d a 2010 C r o s s E x a m
2. T h e A s p e n I n s ti t u te / R o b in a N o v e m b e r 5 - Q uee n s to w n , M D T he A s p e n In stitu te Just ice T r a n s p o r t a t i o n , l o d g i n g , me a l sF o u n d a t i o n N o v e mbe r 7 , 2 0 1 0 a n d S o c i e t y P r o g r a m
3. A me r i ca n C o n f e r e n ce N o v e m be r 3 0 - O rla n d o , F L ACI’s 21 s t Annua l Bad T r a n s p o r t a t i o n , l o d g i n g , me a l sInstitute D e ce mbe r 1 , 2 0 1 0 F a i t h L i t ig a t i o n C o n f e r e n ce
4.
5.
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
Page 4 of 7 Ia m e o f P e rs o n R e p o r t in g
M O N T G O M E R Y , A N N D .
Date of Report
07 /11/2011
V I I . I N V E S T M E N T S a n d T R U S T S - i n e o . ~ e , v u l u e , transactions (Includes those of spouse and de pendent cM Idren; seepp. 3 4-60 of f i ling instructions. )
N O 1 N E (No reportable income, assets, or transactions.)
2.
3.
4.
5.
6.
7.
8.
9.
1 0 .
1 2 .
13 .
1 4 .
15 .
1 6 .
1 7 .
A. B. C. D.
Descr ipt ion of A ssets In com e d urin g G ross va lue a t en d Transact ions dur ing repor t ing per iod
( inc luding t rust asse ts) rep ortin g p erio d o f rep orting perio d
(l ) (2) (1) (2) ( l) (2) (3) (4) (5 )
Place "(X)" after each asset A moun t Typ e (e .g ., Value Value Type (e .g. , D a t e Value G a in Id entity of
exempt f rom pr ior di sclosure Code 1 div., rent, Code 2 Method buy, se l l , m m /d d/yy Co de 2 Code I buyer/se l ler(A-H) o r i n t . ) ( J - P ) Code 3 redempt ion) ( J - P ) (A -H) (if p riva te
(Q-W) t ransact ion)
U S B a n co r p
N o r t e ch S y s te m - C o m mo n S t o ck
M i n n e s o t a S t a t e J u d g e Re t i r e me n t P l a n
A
A
Inte res t
D i v i d e n d
N o n e
J
J
K
T
T
U
1\4 In teres t in farm land in M eeker County ,M N
N e u r o g e n C o r p . H W P - C o mmo n S t o ck
R e n t
N o n e S o l d 06/01/10 J
L i n co l n L i fe V a r i a b l e A n n u i t y F u n d N o n e So l d 03/10/10 L
T r a n s A m e r i ca A n n u i ty N o n e L B uy 03/10/10 L
A l l ia n c e B e m s t e i n B a l a n c e d W e a l th A D i v i d e n dSt ra teg ies
Tota l Re turn - IMCO P1M CO B D i v i d e n d
So l d 02/16/10 L
B uy 02/16/!0 K
P r u d e n t i a l N a t u r a l R e s o u r c e s - P r u d e n t i a l A D i v i d e n d K B uy 02/16/10 K
B l a ck r o ck G l o ba l A l l o ca ti o n - B l a ck r o ck A D i v i d e n d K B uy 02/16/10 K
F i r s t E a g l e G l o ba l F u n d - F i r s t E a g l e A D i v i d e n d K B uy 02/16/10 K
Ivy Asse t Stra tegy - IVY A D i v i d e n d K B uy 02/16/10 K
B l a ck r 0 ck G l o ba l A l l o ca ti o n - I RA - A D i v i d e n dB l a ck r 0 ck
Pruden t i a l Natura l Resources - IRA - A D i v i d e n dP md e n t i a l
Ivy Asset S t ragegy - IRA - IVY A D i v i d e n d
K
K
K
T
T
T
S o l d 02/16/10 M
(pa r t )
B uy 02/16/10 K
B uy 02/16/10 K
F i r s t E a g l e G l o b a l F u n d - IR A - F i r s t E a g l e A D i v i d e n d K B uy 02/16/10 K
A
D
1. Incom e G ain Codes: A = $ 1,000 or less B =$1,001 - $2,500 C = $2,501 o $5 ,000 D = $ 5,001 - $15,000
( S e e Colu mns BI a nd D4 ) F =$50,001 - $100,000 G =$100,001 - $1,000,000 HI =$1,000,001 - $5,000,000 H2 = Mo re t han $5 , 000 , 000
2 . V al ue Codes J = $15 , 000 or l ess K= $15 , 001 - $50 , 000 L =$50,001 - $ 100,000 M -$ 100,001 - $250,000
(See Colum ns C 1 an d D3) N =$ 250.001 - $500,000 O =$500,001 - $ 1,000,000 P 1 = $1 ,000,001 - $5 ,000,000 P 2 = $ 5,000,001 - $ 25 ,000,000
P3 =$25,000,001 ° $50,000.000 P4 = Mo re t han $50 , 000,000
3. V al ue Met hod Codes Q = A ppra i sa l R = Cost (Rea l E s t a t e O nl y ) S = A s s e s s m e n t T = C a s h M a r k e t
( S e e Colu mn C2) U =Book Va lu e V = O t h e r W =Es t ima te d
E = $1 5,0 0 1 - $50 ,0 00
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
V I I . IN V E S T M E N T S a nd T R U S T S - in co ,~ e , v al .e , transactions (Includes those of spouse and dependent ch ildren; seepp. 34-60 of filing instructions.)
D NONE(No reportable incom e, assets, or transactions.)
m. Bo
D e sc r i p t i o n o f A sse t s Income during( in c lu d in g tm s t a s se ts ) r e p o rt in g p e r io d
( 1 ) (2 )
PI ace "(X)" after each asset A m o u n t Type (e.g.,
exempt from prior disclosure C o d e 1 div., rent,
( A - H ) o r i n t . )
G r o ss v a l u e a t e n do f r e p o r t i n g p e r i o d
(1) (2) (1 ) (2) (3) (4) (5 )
V a l u e Value Type (e.g., D a t e V a l u e G a i n Identity of
C o d e 2 M e t h o d b u y , s e l l , mm/dd/yy C o d e 2 C o d e 1 buyer/seller
(J-P) C o d e 3 redemption) (J-P) ( A - H ) (if private
( Q - W ) t r a n s a c t i o n )
T r a n sa 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
1 8 . P i m c o ’ r o ta l R e t u m - I R A - P I M C O B Dividend K T Buy 02/16/10 K I
I. Incom e G ai n Codes :
(See Col um ns B 1 and D 4)
2.V al ue Codes
( S e e Colu mns CI a nd D3 )
3.V al uc Met hod Codes
( S cc Colu mn C2)
A =$1 ,0 0 0 or l e s s
F =$50,001- $100,000
J =$1 5,0 0 0 or l e s s
N =$250,001- $500,000
P3 =$25,000,001- $50,000,000
Q=Appr a i s a l
U =Book Va lu e
B =$1 .0 0 1 - $2 ,50 0
G =$100,001- $1,000,000
K =$15,001 -$50,000
O=$50 0 ,0 0 1 -$1 ,0 0 0 ,0 00
R=C os t (Rea l Es ta te Only)
V =Other
C =$2,501 - $5,000
H I =$1,000,001 - $5,000,000
L -$50,001 - $ 100,000
P 1 = $ 1,000,001 - $ 5,000,000
P4 =More than $50,000,000
S = A s s e s s m e n t
W - E s t im a t e d
D =$5,0 0 1 - $1 5.0 0 0
H2 =More than $5,000,000
M= $1 0 0 ,0 0 1 - $250 ,00 0
P2=$5,000,001- $25,000,000
T = C a s h M a r k c t
E =$15,001- $50,000
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
V III. ADDITIONAL INFORMATION OR EXPLANATIONS. (Indicate part of report.)
S e c t i o n V II : N o . 4 - It e m 4 i s r e a l e s t a te o w n e d i n co m m o r ~ ] ]= ~ T h e a s s e s s e d t a x v a l u e i s a p p r o x i m a t e l y $ 8 0 ,0 0 0 ; t h e c u r re n t v a l u e m a y a c t u a l l y b el es s than that but my share , in any eve n t , would be l es s than $20,000.
8/3/2019 Ann D Montgomery Financial Disclosure Report for 2010
1 c e r t if y t h a t a ll i n f o r m a t i o n g i v e n a b o v e ( i n c l u d in g i n f o r m a t io n p e r t a in i n g t o m y s p o u s e a n d m i n o r o r d e p e n d e n t c h i ld r e n , i f a n y ) i s
a c c u r a te , t ru e , a n d c o m p l e 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 y i n f o r m a 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 p l i c a b le s t a t u to r yp r o v i s i o n s p e r m i t t i n g n o n - d i s c l o s u r e .
1 f u r th e r c e r ti f 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 m e 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 inco m p l i a n ce w i t h t he 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. § 73 5 3 , a n d Ju d i c i a l Co n f e r e n ce r e g u l a t i o n s .
Sign atu re : S/ANN D. MONTGOM ERY
N O T E : A N Y I N D I V ID U A L W H O K N O W I N G L Y A N D W I L F UL L Y F A L S IF IE S O R F A I LS T O F I L E T H IS R E P O R T M A Y B E S U B J E CT T O C I V ILA N D C R I M I N A L SA N C TI O N S (5 U . S . C . a p p . § 1 0 4 )