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___________ _ Date. ____ _ POSITION Cl ...,_ :;:-.=-C) P1 ii

:;1

---,

::

:!:-A0-10 Rev. 1/2004

FI1�ANCIAL DISCLOSURE REPORT

1. Person Reporting (Last name, First name, Middle initial) Collyer, Rosemary M

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

U.S. District Court Judge

Calendar Year 2003

2. Court or Organization District Court - Washington D. 5. ReportType (check appropriate type)

0

Nomination, Date

0 Initial

@Annual

0

Final

Report Required by the Ethics in Government Act of 1978

(5 U.S.C.

app.

§§ 101-111)

3. Date of Report 5/15/2004 6. Reporting Period 1 /1 /2003 to 1213112003 7. Chambers or Office Address

E Barrett Prettyman Courthouse 300 Constitution Avenue, NW

8. On the basis of the infonnation contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable laws and regulations.

Washington, DC 20001 Reviewing Officer

IMPORTANT NOTES: The instructions accompanying this fonn must be followed. Complete all parts, checking the NONE box for each part where you have no reportable infonnation. Sign on last page.

I. POSffiONS.

(Reporting individual only; see pp. 9-13 of filing instructions}

0 NONE

- (No reportable positions.)

NAME OF ORGANIZATION/ENTITY

l. Trustee Trust

#1

2.

3.

(Reporting individual only; see pp. 14-16 of filing instructions}

II.

AGREEMENTS.

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AJ

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0

N co

NONE

- (No reportable agreements.}

PARTIES AND TERMS l.

(2)

GROSS

SOURCE AND TYPE

J

fl/

SOURCE DESCRIPTION

I INAJ. CIAL DISCLOSURE REPORT

Name of Person Reporting

Collyer, Rosemary M

Date of Report 5/1512004

ill.

NON-INVESTMENT INCOME.

(Reporting individual and spouse; see pp. 17-24 of filing instructions)

A. Filer's Non-Investment Incom

D NONE

- (No reportable non-investment income.)

SOURCE AND TYPE INCOME

(yours, not spouse's)

l. 2003 Crowell & Moring U.P, Distribution of Capital Account 239,998

2.

3.

B. Spouse's Non-Investment Incom

(If you were married during any portion of the reporting year, please complete this section. (dofiar amount not required except for honoraria)

NONE

-(No reportable non-investment income.)

l.

N. REIMBURSEMENTS

-transportation, lodging, food, entertainment. {Includes those to spouse and depen ent children. See pp. 25-27 of instructions.)

NONE

- (No such reportable reimbursements.)

l.

(3)

CREDITOR VALUE

l'.'INANCIAL DISCLOSURE REPORT

Name of Person Reporting

Collyer, Rosemary M

Date of Report 5/15/2004

V. GIFTS.

(Includes those to spouse and dependent children. See pp. 28-31 of instructions.)

0 NONE

-(No such reportable gifts.)

SOURCE DESCRIPTION

!. Crowell & Moring LLP Engraved crystal gavel

2. Crowell & Moring LLP Labor & Tiffiny brass clock Employment Law Group

3. Occidental Chemical Corp. Crystal decanter and glass

VALUE $350 $450

$300

4. R. Emmett Boyle and Debbie Bolger Crystal vase $300

VI. LIABILITIES.

(Includes those of spouse and dependent children. See pp. 32-34 of instructions.)

0 NONE

-(No reportable liabilities.)

DESCRIPTION 1.

(4)

(3) (4)

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Fii Al CIAL DISCLOSURE REPORT

Name of Person Reporting Date ofRepmt

Page

1of7

Collyer, Rosemary M

5/15/2004

- income, value, transcations (includes those of the spouse and dependent children. See pp. 34-57 of filing instructions.)

. vrr.

INVESTMENTS

and

TRUSTS

A. B. c. o.

Income during Gross value at end of Transactions during reporting period

Description of Assets reporting period reporting period

(including trust assets)

(I) Ifnot exempt fiom disclosure

(I) (2) (I) (2) Place "(X)" after each asset exe111>t

fiom prior disclosure

DNONE

(No reportable income, assets, or transactions) 1. QUALIFIED RETIREMENT PLAN #I

2. - Fidelity Aggressive Growth Fund

3. - Sequoia Fund

4. - Fidelity Spartan US Equity Index Fund

5. -Fidelity Puritan Fund

6. - Fidelity Diversified International Fund 7. -Fidelity Managed Income Portfolio II (Stable

Value Fund)

8. -Fidelity Money Market Mutual Fund 9. BROKERAGE ACCOUNT #1 Nmunt Code I (A-H)

-Type {e.g. div. rcnl or inl)

-Value Value Code2 Method (J-P) CodeJ (Q-W)

...

..

:

..

..

:

..

..

:

..

;

..

Type (e.g. buy, sell, merger, redemption) Sell Sell Sell Sell Sell Sell Sell (2) Date: Month-Day 10/15 10115 10/15 11/18 11118 10/15 11125 Value Code2 (J-P)

Gain Code I (A-H)

-(5) Identity of buyer/seller (if private transaction) 10. -AA-Common

- - ..

, Buy 1/16

.!

11.

-

... ..

Partial Sale 1114

12. - AA - Call Option

- - ..

Sell Short 4/15

13. 14. - ADRX -Common

-

.. ..

..

Exercised Sell 11/4 6120

15. - ADRX - Call Option

16. 17. -AFC -Common 18. - APPX - Common

-..

.. ..

.. ..

Sell Short Exercised Buy 4/11 6120 4/24

1. Income/Gain Codes: = $1.000 or less B = SI,00l-S2,500 = $2,501-$5,000 D = $5,001-$15,000 E = $15,001-$50,000

(See Colwnns Bl 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 = St5,001-$50,000 L = $50,001-$100,000 M = $100,001-$250,000

(See Columns Cl and D3) N = $250,000-$500,000 0 = $500.001-$1,000,000 Pl = $1,000,001-$5,000,000 P2 = $5,000,00!-$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

(5)

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-A c E s u v D. (2) (Q-W) 4/24 32. 35.

Fl ANCIAL DISCLOSURE REPORT

Name of Person Reporting Date of Report

Page

2of7

Collyer, Rosemary M 5/15/2004

VII.

INVESTMENTS

and

TRUSTS

- income, value, transcations (inclu des those of the spouse and dependent children. See pp. 34-57 of filing instructions.)

B. c. A.

Income during Gross value at end of Transactions during reporting period

Description of Assets reporting period reporting period

(inclu ding trust assets)

lfnot exempt from disclosure

(\) (2) (\) (2) (l)

(3) (4) (5)

Place "(X)" after each asset exempt Atmlllll Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of ftom prior disclosure Code I div. rent or Code 2 Method buy, sell, Monlh - Codc2 Code I buyerfseller

merger,

(A-H) int) (J-P) Code 3 Day (J-P) (A-H) (if private

redemption) transaction)

19.

-

...

Sell 7/18

20. - APPX - Call Option

-

..

Sell Short

-,

..

21.

-

..

Exercised 7/18 - BRKA - Common Class A

22.

-:

..

23. - BVF -Common (X)

-

Sell 10/10

24. - BVF -Call Option

- ..

Sell Short 3/28

Expired 10118 25.

- -

..

-CMGI -Common 26.

..

••

27. - CMS - Common (X)

- ..

Sell 1/8 - CNP -Common (X) 28.

-

..

29. - DD-Common

- ..

Buy 1/16 30. -DD - Call Option

-

Sell Short 512

'

..

;

31. - EP -Common (X)

-

Sell 7n

33.

- GE - Common Buy 1/16

-

Partial Sale 12/26

34. -GE -Call Option

- ... ..

Sell Short 3/14

36.

Exercised 12126

-Buy 1/16

- GM-Common

I. Income/Gain Codes: = $1,000 or less B = $1,00lc$2,500 = $2,501-$5,000 D = $5,001-$15,000 - $15,001-$50,000

(See Columns BI and D4) F = $50,001-SI00,000 G = $100,001-$1,000,000 Hl = $1,000,001-$5,000,000 H2 =More than $5,000,000

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

(See Columns Cl and D3) N = $250,000-$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) = Assessment T = CashfMarket

(6)

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B c D E u v (2) (I) (4) (A-H) 37. 45. 54. Date of Report Name of Person Reporting

Page 3 of 7

Collyer, Rosemary M 5/15/2004

VIL

INVESTMENTS and TRUSTS

- income, value, transcations (includes those of the spouse and dependent children. See pp. 34-57 of filing instructions.)

A. B. c. D.

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

FINANCIAL DISCLOSURE REPORT

(including trust assets)

(I) (2) (1) lfnot exempt fiom disclosure

(2) (5)

Place "PO" after each asset exempt Ammmt Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of Code 2 Method

Code 1 Code 2

from prior disclosure div. renl or buy, sell, Month- Code! buyer/seller

inl) (J-P) Code3 merger, Day (J-P) (A-H) (ifprivate

(Q-W) redemption) transaction)

-GM - Call Option

- - ..

Sell Short 6/12

- HON - Common Buy 1/16

38.

- .. ..

39. -HON - Call Option

- ..

Sell Short 5/14

,

..

- ILA -Common

(X)

Sell 11/17

40.

..

-41. - INTC -Common

-42. -INTC -Call Option

-

Sell Short 10/31

43. - JPM - Common

- - .. ..

Buy 1/16

Sell 12131

44.

- -!

- JPM -Call Option

- ..

Sell Short 4/14

.

...

Exercised 12131

-

..

,

..

46. 47. - MDCl - Common

(X)

-

..

48. -MLNM -Common

(X)

-

..

--MO-Common Buy 1116 49.

..

Partial Sale 12117 50.

..

Sell Short 5/22 51. -MO -Call

Op

tion

Exercised 12117 52.

..

53. -MSFT -Common Buy 10/8 -NPSP - Common

.. ..

l. fncorue/Gain Codes:

(See Columns B 1 and 04)

2. Value Codes: A F J = $1.000 or less =$50,001-$100,000 = $15,000 or less G K = $1,001-$2,500 = $100,001-Sl,000,000 = $15,001-$50,000 = $2,501-$5,000 HI = Si,000,001-$5,000,000 L = $50,001-$100,000 = $5,001-$15,000 H2 =More than $5,000,000 M = $100,001-$250,000 = $15,001-$50,000

(See Colwnns Cl and DJ) N = $250,000-$500,000 P3 = $25,000,001-$50,000,000

0 = $500,001-$1,000,000 Pl = $1,000,001-$5,000,000

P4 = $More than $50,000,000

P2 = $5,000,001-$25,000,000

3. Value Method Codes Q =Appraisal R =Cost (Real Estate Only) s = Assessment T = Cash/Market (See Colwim C2) =Book Value =Other w =Estimated

(7)

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li'INANCIAL DISCLOSURE REPORT

Page 4of7

Name of Person Reporting

Collyer, Rosemary M

Date of Report 5/15/2004

VII. INVESTMENTS and TRUSTS

- income, value, transcations (includes those of the spouse and dependent children. See pp. 34-57 of filing instructions.)

A. B. c. D.

Income during Gross value at end of Transactions during reporting period

Description of Assets reporting period reporting period

(including trust assets)

(I) (2) (!) (2) (I) Ifnot exempt fiom disclosure (2) (3) (4) (5) Place "(X)" after each asset exempt Almunt Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of from prior disclosure Code I div. rent. or Code 2 Method buy, sell, Month- Code 2 Code I buyer/seller

(A-H) int.) (J-P) Code3 mciger, Day (J-P) (A-H) (if private

(Q-W) redemption) transaction)

55. - PFE - Common

-

..

56.

-

..

Buy 1116

57. - PFE - Put Option (Exp 1116/03)

(X)

Partial 1/16

Exer

58. Buy to 1/17

Close

59. -PFE - Put Option (Exp 1/17/04)

-

Sell Short 315

60. - TON - Common

-

Spinoff 1/6

-61. - XEL -Common (X)

- - .. ..

Sell 118

62. - XOM -Common

-

:

- .. ..

Buy 1/16

••

63. -XOM -Call Option

-

Sell Short 3/17

64. - ING Emerging Countries Class A Fund

-

..

Sell 1/17 65. -Fidelity Spartan

_ Maryland Mun Fund

-

..

Sell 8129

-66. - Fidelity Spartan Mun Money Mkt Fund

-:

..

,

Sell 9/11

-67. - Massachusetts Muni Bonds

-

..

68. - NY Urb Dev Muni Bonds

-

.. ..

Sell 1/1

69. - Hopkins, MN Muni Bonds

-

..

Sell 211

70. - MD Gen Obi Muni Bonds (10/15/09)

-

..

71. - MD Gen Obi Muni Bonds (10/15/11)

72. -Anne Arundel Co MD Muni Bonds

I. Income/Gain Codes: A = $1,000 or less B = Sl,001-$2,500 c = $2,501-$5,000 = $5,001"$15,000 . E = $15,001-$50,000 (Sec Colwnns B 1 and 04) F = $50,001-$100,000 G = $100,001-$1,000,000 HJ =Sl,000,001-$5,000,000 H2 =More than $5,000,000

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

(See Colunms Cl and DJ) N = $250,000-$500,000 0 = $500,001-$J ,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

(8)

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B c D E u v (2) (3) (A-H) 73. 75. 79. 83. 87.

FINANCIAL DISCLOSURE REPORT

Name of Person Reporting Date of Report

Page 5of7

Collyer, Rosemary M 5/15/2004

VII.

INVESTMENTS and TRUSTS

- income, value, transcations (includes those of the spouse and dependent children. See pp. 3 4-57 of filing instructions.)

A. B. c. D.

Income during Gross value al end of Transactions during reporting p eriod

Description of Assets reporting period reporting period

(including trust assets)

(1) (1) (2) (1)

(2)

If not exempt from disclosure (5) Place "(X)" after each asset exempt Amount Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of

fiom prior disclosure Code 1 div. rent. or Code2 Method buy, sell, Month· Code2 Codel buyer/seller

(A-H) inl) (J-P) Code3 merger, Day

(Q-W) redemption) (J-P) (if private transaction)

-Balta MD Const Pub hnp Muni Bonds

-

..

;

74. - MD Health&Higher Ed Faes Muni Bonds (7/1113)

.. ..

••

-- MD Health&Higher Ed Faes Muni Bonds (7/1/23)

- ..

76. -Fidelity Core Account (Cash)

-

..

Sell 9/11

77. -US Trust Co -CD

-: -

..

Buy 9/19

78. IRA#l

-

-i

-GT-Common

-

Buy 9/11

·

- .. ..

i

80. - GT Call Option

- -I .. ..

Sell Short 9/11

.

-81. - VRTX -Common

-

.. ..

Sell 1117

••

Buy 1/17

.i

-XOMA -Common

82.

-j

..

-

Sell Short 9/8

- XOMA - Call Option

.. ..

-Schwab Money Market Fund Account

84.

-

..

.

..

-85. IRA#2

- ..

,

-86. - ADRX -Common

-

Buy 8/14

88.

- ADRX -Call Option

-

Sell Short 10/30

·

-

..

- APHT - Common

- .. ..

Partial Sale 6120

89. - APHT -Common

- -

Sell 7/9

90. -BCRX - Common

-

..

Buy 11/11

..

.

= $2,501-$5,000 = $5,001-$15,000 = $15,001-$50,000

l. Income/Gain Codes: A = $1,000 or Jess = $1,001-$2,500

(See Colwtms Bl aud D4) F = $50,001-$100,000 G =$100,001-$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 = $15,001-$50,000 L = $50,001-$100,000 M = $100,001-$250,000

(See Columns Cl and DJ) N = $250,000-$500,000 0 = $500,001-$1,000,000 Pl = $1,000,0Ql-$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

(9)

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c D E u v w

FiNANCIAL DISCLOSURE REPORT

Page 6of7

Name of Person Reporting Collyer, Rosemary M

Date of Report

5115/2004

VII.

INVESTMENTS

and

TRUSTS

- income, value. transcations (includes those oftlie spouse and dependent children. See pp. 34-57 of filing instrnctions.)

A. 8. c. D.

Income during Gross value at en d of Transactions during reporting period

Description of Assets reporting period reporting period

(including trust assets)

(1) (2) (1) (2) (1) If not exempt trom disclosure

(2) (3) (5)

Place "(X)" after each asset exempt Arno wit Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of

fium prior disclosure Code 1 div. rent. or Code 2 Method buy, sell, Month- Code 2 Code! buyer/seller

(A-H) int.) (J-P) Code 3 merger, Day (J-P) (A-H) (if private

(Q-W) redeJl1>tion) transaction)

91.

- -

Buy 12123

92. - ELGX - Common

-

..

:

-93. - GT-Common

-

..

Buy 9/11

94. - GT -Call Option

..

Sell Short 9/11

95. - HGSI - Common

- -

..

Sell 12123

96. - HGSI - Call Option

- -

.. ..

Sell Short 616

97.

-

..

Expired 10/18

98. - JCOS -Common

..

.

..

Buy 9/8

••

-99. - ICOS -Call Option

- -

Sell Short 918

100. - IVX -Common

- -1

..

:

Partial Sale 9/19

101.

- -

..

Sell 12123

102. - MTSX -_Common

- -

..

103. - MLNM -Common

-

.. ..

Sell 11121

104. - MLNM - Call Option (Exp 8116103)

-

..

Sell Short 5128

-105.

- -

..

.

..

Expired 8/16

106. - MLNM - Call Option (Exp 11/22/03)

..

.

..

Sell Short 8/22

107.

- -

Exercised 11/21

108. - NBIX -Common

.. ..

Sell 2/21

l. Income/Gain Codes: A = $1,000 or less B = $1,001-$2,500 = $2,501-$5,000 = $5,001-$15,000 - $15,001-$50,000

{See ColWIDIS BI and D4) F = $50,001-$100,000 G = $100,001-$1,000,000 HI =$1,000,001-S5,000,000 H2 = More .than $5;000,000

2. Value Codes: J = $15,000 or less K = $15,001-$50,000 L = $50,001-$100,000 M = $100,001-$250,000 (See ColWIDIS Cl and DJ) N = $250,000-$500,000 0 = $500,001-$1,000,000 Pl = Sl,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

(10)

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-B c D E J u B. (J-P) 914

FINANCIAL DISCLOSURE REPORT

Name of Person Reporting Date of Report

Page 7of7

Collyer, Rosemary M 5/15/2004

VII.

INVESTMENTS

and

TRUSTS

-- income, value, transcations (includes those of the spouse and dependent cluldren. See pp. 34-57 of filing instructions.j

A. D.

Transactions during reporting period

c.

Gross value at end of Income during

Description of Assets reporting period reporting period

(including lruSt assets)

Ifnot exempt liom disclosure

(!) (2) (1) (2) (1)

{2) (3) (4) (5)

Place "(X)" after each asset exempt Amount Type (e.g. Value Value Type (e.g. Date: Value Gain Identity of

ftom prior disclosure Code 1 div. rent or Code2 Method buy, sell, Month- Code 2 Code I buyer/seller merger,

(A-H) int) (J-P) Code3 Day

(Q-W) redemption) (A-H) (if private transaction)

109. -WM-Common

- -

Buy

- Schwab Money Market Fund Account

110.

-

.. ..

•:

111. - UST Inflation Index Notes 3.375% 1115/12 TIPS

-IRA#3

112.

-

..

:

-BRKB -Common Class B

113.

-

•:

-114. -C-Common

-

..

Buy 1215

115. - IDEV -Common

- -

..

.

..

.

Buy 12123

116. - PLMD

-

Common

-

..

Buy 1215

•:

117. ll8. 119. 120. 121.

- UST Inflation Index Notes 3.375% 1/15/12 TIPS

--Schwab Money Market Fund Account

Merrill Lynch Account

Citibank Account Trust#!

-j

-..

••

..

Buy 11/25

••

..

I. Income/Gain Codes: A = $1,000 or less = $1,001-$2,500 = $2,501-$5,000 = $5,001-$15,000 = $15,001-$50,000

(See Columns Bl and D4) F = $50,001-$100,000 G = $100,001-$1,000,000 HI = $!,000,00!-$5,000,000 H2 = More than $5,000,000 2. Value Codes: = $15,000 or less K = $15,001-$50,000 L =$50,001-$100,000 M = $100,001-$250,000

(See Colunms Cl and D3) N = $250,000-$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

(11)

511512004

Name of Person Reporting Date of Report

FINANCIAL DISCLOSURE REPORT

Collyer, Rosemary M

(Indicate part of Report.)

VIIl. ADDITIONAL INFORMATION OR EXPLANATIONS

There are several discrepancies between this report and the initial disclosure report, dated 5/29/02. Unless otherwise noted, the following comments apply

to Section VII.

A. On the initial report, Lines 44-56 represent securities sold in 200 l. Therefore they have been removed from the current report.

B. On the initial report, Lines 16, 24 and 33 represent securities sold in 2002 (after 5129). Therefore they have been removed from the current report.

C. On the initial report, Line 20 (ING Asia Pacific Equity Class A Fund) appears under a different name in the current report (ING Emerging Countries

Class A Fund).

D.

On the initial report, Line 27

(MD

Gen Obi Muni Bonds) and Line 30

(MD

Health & Higher Ed Faes Muni Bonds) each appear under two separate lines in the current report, as they each represent two different issues with different maturity dates.

E. On the initial report, Lines I and 2 now appear under IRA #1.

F. On the initial report, Lines 3 -8, and 10 appear in the current report under QUALIFIED RETIREMENT PLAN #1. That account was closed in 2003

and assets were transferred to IRA #3.

G. On the initial report, Lines 9 and 11 now appear under IRA #3.

H. On the initial report, Lines 12 - 31 now appear under BROKERAGE ACCOUNT #1. I. On the initial report, Lines 32 -41 now appear under IRA #2.

J. On the initial report, the Insurance Trust referred to in Section I, Line 3 and in Section

VIl,

Line 57 is now referred to as Trust #1.

(12)

/2

Zro4-FINANCIAL DISCLOSURE REPORT

Name of Person Reporting Date of Report

Collyer, Rosemary M 5/15/2004

IX. CERTIFICATION.

I

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. § 501 el seq., 5 U.S.C. § 7353, and Judicial Conference regulations.

Date

NOTE:

ANY

INDIVIDUAL WHO .KNOWINGLY

AND WILFULLY

FALSIFIES OR FAILS TO

FILE mrs

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

References

Related documents

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