Opinion
January 17, 2006
STATE OF NEW HAMPSHIRE SUPREME COURT OF NEW HAMPSHIRE ORDER
After consultation with the administrative council and pursuant to Supreme Court Rule 38, Canon 4H and the court's constitutional and supervisory authority, the supreme court approves the New Hampshire Judicial Branch Financial Disclosure Statement form set forth in Appendix A. This form shall be used by judges to fulfill the requirements of Supreme Court Rule 38, Canon 4H(2)(b) with respect to calendar year 2007, and shall be filed with the clerk of the New Hampshire Supreme Court on or before April 15, 2008.
Date: January 17, 2006 ATTEST: ______________________________ Eileen Fox, Clerk Supreme Court of New Hampshire
Appendix A
This report is required by Canon 4H(2)(b) of Supreme Court Rule 38, the Code of Judicial Conduct. This report must be filed with the Clerk of the New Hampshire Supreme Court by April 15, 2008, with respect to calendar year 2007.
PART I — PUBLIC REPORT OF COMPENSATION RECEIVED FOR QUASI-JUDICIAL AND EXTRA-JUDICIAL ACTIVITIES
__________________________________________________________________________ Name: Court:
__________________________________________________________________________ Judicial Position: Official Address:
__________________________________________________________________________ Reporting Period: Beginning January 1, 2007, and ending December 31, 2007
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Please type or print all information. If additional pages are needed to complete any part of this Financial Disclosure Statement, attach those sheets, with the applicable paragraph number, to the statement.
A. Remuneration received for quasi-judicial and extra-judicial activities during the reporting period (include nature of activity, name of payor, and amount received):
B. Reimbursement for travel, food and lodging have been reasonable, limited to the actual cost thereof and in many cases less than the actual cost thereof during the reporting period. At no time has there been any excess expense reimbursement, except as set forth below. See Supreme Court Rule 38, Code of Judicial Conduct, Canon 4H(1).
C. Gifts, bequests, favors or loans required to be reported under Supreme Court Rule 38, Code of Judicial Conduct, Canon 4D(5)(h). During the reporting period, no such gifts, bequests, favors or loans have been received by me or any member of my family residing in my household, except as set forth below.
PART II — FINANCIAL DISCLOSURE
A. Disclose each source of your income or your spouse's income in excess of $5000 for calendar year 2007. You are not required to disclose the names of individual clients or patients or the dollar amount of the income received. The general source such as "professional service" or "rental income" must be disclosed.
SOURCE PAYMENT TO (Self/Spouse)
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B. Disclose the city or town and particular use of any real estate, other than owner occupied residential, in which you or your spouse, on December 31, 2007, had a legal or beneficial interest and which had a fair market value of $2,500 or more, and which was located in this state or any adjacent state.
LOCATION NATURE OF USE
(City or Town) (Unimproved vacant land, agricultural land, rental, commercial building, apartments, single family, etc.) _____________________________ ____________________________________ _____________________________ ____________________________________ _____________________________ ____________________________________ _____________________________ ____________________________________ _____________________________ ____________________________________ _____________________________ ____________________________________ C. Disclose the name of each creditor to whom you or your spouse, on December 31, 2007, owed $5,000 or more. You are not required to disclose a personal mortgage debt, a personal car loan, or a personal educational loan.
DEBTOR CREDITOR
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D. List each business entity in which you or your spouse or a member of your household was, at any time during calendar year 2007, a trustee, beneficiary of a trust, director, officer, owner (in whole or in part), limited or general partner, or holder of any class of stock or security representing one percent or more of the total outstanding stock or securities issued by the business entity.
HELD BY (Self/Spouse/Other BUSINESS ENTITY Household Member)
_______________________________ ____________________________________
_______________________________ ____________________________________
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I DECLARE THE INFORMATION CONTAINED IN THIS STATEMENT IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
________________________________ ____________________________________ SIGNATURE DATE (Statement must bear original signature)