Fillable DISCLOSURE REPORT CALENDAR YEAR 2020 INANCIAL T Canon (Kansas Judicial Branch)

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DISCLOSURE REPORT CALENDAR YEAR 2020 INANCIAL T Canon (Kansas Judicial Branch)

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FDR ♦ CY 2020 | Page 1
J
UDICIAL
F
INANCIAL
DISCLOSURE REPORT
A
TTN
:
F
INANCIAL
D
ISCLOSURE
R
EPORTING
301 SW 10
TH
AVENUE
T
OPEKA, KANSAS 66612
785-368-8740 ♦ financialdisc@kscourts.org
The instructions accompanying this form are a guide to be followed in preparing your annual
financial disclosure report. Please read the instructions and review Supreme Court Rule 601B,
Canon 3, Rules 3.12, 3.13, 3.14, and 3.15 and their Comments before completing this form.
Complete all parts, checking “NONE” wherever you have no reportable information. This report
must be typed, and an on-line fillable form is available at www.kscourts.org. Completed and
signed reports may be submitted by U.S. mail to the address reflected above or may be scanned
and submitted by e-mail to financialdisc@kscourts.org
ON OR BEFORE APRIL 15, 2021.
Judge Reporting - Full Name County or City
Court & Judicial Address with City, State, and Zip Code
Email Address Telephone Number
Type of Judge: _____ Supreme Court _____ Dist. Magistrate _____ Pro Tempore
_____ Court of Appeals _____ Senior Judge _____ Hearing Officer
_____ Dist. Chief Judge _____ Municipal – Full time
_____ District Judge _____ Municipal – Part time
I. COMPENSATION [reporting individual (I), and spouse (S) or domestic partner (DP); for
Honoraria, reporting individual (I) only; see Section I of Instructions and Rule 3.15(A)(1).]
___ NONE (No reportable Compensation)
Date
Name of Payor Nature of Activity
Payee (I,S,DP)
Judge:
♦
CALENDAR YEAR 2020
♦
REPORT REQUIRED BY SUPREME COURT RULE 601B
R
ELATING TO
J
UDICIAL
C
ONDUCT
C
ANON
3,
R
ULE
3.15(B)
(check one)
FDR ♦ CY 2020 | Page 2
II. FEES AND COMMISSIONS [reporting individual (I) and spouse (S) or domestic partner (DP);
see Section II of Instructions and Rule 3.15(A)(2).]
___ NONE (No reportable Fees and Commissions)
Client or Customer Name Client or Customer Address
Payee (I,S,DP)
III. OWNERSHIP INTERESTS [reporting individual (I), spouse (S) or domestic partner (DP),
dependent child or dependent stepchild (DC); see Section III of Instructions and Rule 3.15(A)(3).]
___ NONE (No reportable Ownership Interest)
Business Name
Held by
Type of Business Business Address
Whom
(Address only if not publicly traded)
(I,S,DP,DC)
Judge:
Description
of the
___Interest Held___
Judge: __
FDR ♦ CY 2020 | Page 3
IV. GIFTS, LOANS, BEQUESTS, BENEFITS, OR OTHER THINGS OF VALUE
[reporting individual (I), spouse (S) or domestic partner (DP), dependent child or
dependent stepchild (DC); see Section IV of Instructions and Rules 3.13 and 3.15(4).]
___ NONE (No reportable Gifts, Loans, Bequests, Benefits, or Other Things of Value)
Date
Donor
Description of Donation
Recipient
(I,S,DP,DC)
V. POSITIONS [reporting individual (I) only; see Section V of Instructions and Rule 3.15(A)(6).]
___
NONE (Nothing to report)
Organization/Bu
siness/Entity Name Organization or Business Address
Position Held
Judge: FDR ♦ CY 2020 | Page 4
VI. LIABILITIES [reporting individual (I), spouse (S) or domestic partner (DP), dependent child
or dependent stepchild (DC); see Section VI of Instructions and Rule 3.15(A)(7).]
___ NONE (No reportable Liabilities)
Creditor’s Name Description of Debt
VII. ADDITIONAL INFORMATION OR EXPLANATIONS (Indicate section of Report)
___ NONE (No additional information to report)
____________________ _________________________________________
Date Signature of Reporting Judge
Person Responsible
for Debt (I,S,DP,DC)
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DISCLOSURE REPORT CALENDAR YEAR 2020 INANCIAL T Canon (Kansas Judicial Branch)

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Completed 20 March 2021

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