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STATE OF VERMONT OFFICE OF THE COURT ADMINISTRATOR (Vermont Judiciary)

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800-00007 - Annual Financial Disclosure Statement (09/2019) Page 1 of 3
STATE OF VERMONT
OFFICE OF THE COURT ADMINISTRATOR
ANNUAL FINANCIAL DISCLOSURE STATEMENT
The following report is filed pursuant to Rule 3.15 of the Vermont Code of Judicial Conduct 2019.
Financial information for calendar year: ___________________
Name of Reporter: _____________________________________
Status:
☐ Supreme Court Justice
☐ Superior Judge
☐ Magistrate
☐ Hearing officer
☐ Probate Judge
☐ Assistant Judge
1. Compensation.
Full-time Judges (Supreme Court Justice, Superior Judge, Magistrate, Hearing Officer): List
compensation for any extra-judicial activity permitted by the Code such as payments for
teaching at programs, speaking fees, or honoraria.
Continuing Part-time Judges (Probate Judge, Assistant Judge): List compensation for any
extra-judicial activity, including the practice of law. The general service should be listed, for
example, legal services, but individual clients need not be listed.
☐ I have no sources of income I am required to list.
Source of Compensation
Service Provided
Amount
$
$
$
$
2. Ownership Interest in Business.
If you, a spouse, or partner has an ownership interest in a business, list the name and
nature of the business. Any interest in a closely held or family business should be reported,
regardless of percentage ownership. An interest of 10% or less in a publicly held
corporation need not be reported but is subject to the disclosure required by (4).
☐ I have no business names I am required to list.
Name of Business
Nature of Business
800-00007 - Annual Financial Disclosure Statement (09/2019) Page 2 of 3
3. Real Estate Used for Rental Income (either held individually or co-owned).
You must disclose the amount of gross rental income attributable to you regardless of
whether (1) you have an active or passive role in the rental business, (2) the rental business
has a net gain or loss, or (3) the property is co-owned with other family members.
Ownership in an investment fund, which in turn owns real property, need not be reported
but is subject to the disclosure required by (4).
☐ I have no real estate that I am required to list.
County in which
rental property
located
Name of co-owner
(unless a family member)
Name of Tenant
Gross Rental Income
Attributable to
Reporter
$
$
4. Investments.
If you have an investment over $5,000 in any entity appearing as a party in a suit before
you, you agree by signing this form that you will disclose this fact to all parties at the
beginning of the suit or whenever such investment occurs. You are not required to disclose
the value of the investment.
5. Sources of Gifts Individually Valued in Excess of $500.
You are not required to disclose gifts from family members.
☐ I have no sources of gifts that I am required to list.
Source of gift
Date received
6. Travel Expenses and Scholarships for Seminars/Education.
Scholarships that are given to you directly or to the State on your behalf must be listed.
You are not required to list expenses related to Judicial College and similar judiciary-
sponsored in-state meetings.
☐ I have no reimbursements or scholarships I am required to list.
Source
Nature of event
Amount
$
$
$
$
800-00007 - Annual Financial Disclosure Statement (09/2019) Page 3 of 3
7. Other Income.
You must list sources of income in excess of $1,000 from services that are not listed above.
☐ I have no other income I am required to list.
Source
Nature of service rendered
Amount
$
$
$
$
8. Remarks:
Date: ___________________________ Signature of Reporter: ________________________
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STATE OF VERMONT OFFICE OF THE COURT ADMINISTRATOR (Vermont Judiciary)

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Completed 23 November 2020

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