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Judicial Watch • Donetta W Ambrose Financial Disclosure Report for 2004

Donetta W Ambrose Financial Disclosure Report for 2004

Donetta W Ambrose Financial Disclosure Report for 2004

Page 1: Donetta W Ambrose Financial Disclosure Report for 2004

Category:Financial Disclosure

Number of Pages:7

Date Created:January 5, 2006

Date Uploaded to the Library:November 13, 2013

Tags:MAGEE, Women, Donetta W Ambrose, children, dependent, 2004, INVESTMENTS, investment, TRUSTS, IRS, Financial Disclosure, ICE, CIA, income, Judge


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AO-lO(WP) 	ired the Ethics 
ment Act 1978,
Rev. 1/2004 
FINANCIAL .DISCLOSURE REPORT 
App. 101-111) 
FOR CALENDAR YEAR 2004 Person Reporting (Last name, first, middle initial) AMBROSE, DONETTA Court Organization DIST. CT. WEST. DIST. Date Report 51912005 Title (Article Ill judges indicate active senior status; magistrate judges indicate fall-or part-time) Chiefll. District .Judl!'e  5.Report Type (check appropriate type) Nomination, Date Initial __x_ Annual Final-- Reporting Period 1/1/2004 12/31/2004 Chambers Office Address 620 Post Office Courthouse 700 Grant Street Pittsburgh, 15219-1906  8.0n the basis the information contained this Report and any modifications pertainin thereto, is, opimon,in compliance with applicab laws and regulat10ns. Reviewing Officer Date  

IMPORTANT NOTES: The instructions accompanying this form must followed. Complete all parts, checking the NONE box for each part where you have reportable information. Sign last page. 	POSITIONS. (Reporting individual only; see pp. 9-13 Instructions.} POSITION NAME 
NONE (No reportable positions.) 
TRUSTEE 	NEW PENNSYLVANIA 
MEMBER 	BOARD DIRECTORS -MAGEE WOMEN'S HOSPITAL 
MEMBER 	BOARD DIRECTORS-MAGEE WOMEN'S HEALTH FOUNDATION 
II. AGREEMENTS. (Reporting individual only; see pp. 14-16 oflnstructums.) 
DATE PARTIES AND TERMS 

NONE (No reportable agreements.)  2004  Commonwealth Penns Ivania Blue Cross/Blue Shield Retired ee's Health Care ii!nefit Pia -r,  

C:l>
III. NON-INVESTMENT ME. (Reporting individual and spouse; see pp. 17-24 InstrudionJ!i-Z:.
DATE SOURCE AND TYPE 

-ri 
('") Filer's Non-Investment Income 	f"'1  NONE (No reportable non-investment income.)  2004  State  Retirement  21,251 Spouse's Non-Investment Income -If you were married during any portion the reporting year, please complete this 
section. (dollar amount not required except for honoraria) 
NONE (No reportable non-investment income.) 

2004 Law Practice 
2004 

Date Report 
5/9/2005 
VII. Page INVESTMENTS and TRUSTS --income, value, transactions (Includes those spouse and dependent children. See pp. 34-57 Instructions.)  Income/Gain Codes:  A=$1,000 less  B=$1,001-$2,500  C=$2,501-$5,000  D=$5,001-$15,000  
E=$ l5,001-$50,000  
(See Col. Bl, 04)  F=$50,001-$100,000  0=$100,001-$1,000,000  Hl=$1,000,001-$5,000,000  H2=More than $5,000,000  Value Codes:  J=$15,000 less  K=$15,001-$50,000  L=$50,00I-$100,000  M=$J00,001-$250,000  
(See Col. Cl, 03)  N=$250,001-$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  

Date Report 
5/9/2005 
VII. Page INVESTMENTS and TRUSTS --income, value, transactions (Includes those spouse and dependent children. See pp. 34-57 Instructions.)  Inco me/Gain Codes:  A=$1,000 less  B=$1,00I-$2,500  C=$2,501-$5,000  0=$5,001-$15,000  
E=$15,00I-$50,000 (See Col. Bl, 04)  F=$50,00I-$100,000  0=$100,001-$1,000,000  H1=$1,000,00I-$5,000,000  H2=More than $5,000,000  Value Codes:  J=$15,000 less  K=$15,001-$50,000  L=$50,001-$100,000  M=$100,00 l-$250,000  
(See CI, 03)  N=$250,00 l-$500,000  0=$500,00 I-$ !,000,000  Pl=$!,000,00!-$5,000,000  P2=$5,000,001-$25,000,000  
P3=$25,000,001-$50,000,000  P4=More than $50,000,000  

Date Report 
5/9/2005
VII. Page INVESTMENTS and TRUSTS --income, value, transactions (Includes those spouse and dependent children. See pp. 34-57 Instructions.) 

Income/Gain Codes:  A=$1,000 less  B=$1,00l-$2,500  C=$2,501-$5,000  D=$5,001-$15,000  
E=$ 5,001-$50,000  
(See Col. Bl, 04)  F=$50,001-$100,000  G=$100,001-$1,000,000  H1=$1,000,001-$5,000,000  H2=More than $5,000,000  Value Codes:  J=$15,000 less  K=$15,00J-$50,000  L=$50,001-$100,000  M=$100,001-$250,000  
(See Col. Cl, D3)  N=$250,001-$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  

Date Report 
5/9/2005
VII. Page INVESTMENTS and TRUSTS --income, value, transactions (Includes those spouse and dependent children. See pp. 34-57 Instructions.)  Income/Gain Codes:  A=$I,OOO less  B=$1,001-$2,500  C=$2,501-$5,000  0=$5,001-$15,000  
E=$15,00!-$50,000  
(See Col. Bl, D4)  F=$50,00!-$100,000  G=$!00,001-$1,000,000  H!=$1,000,001-$5,000,000  H2=More than $5,000,000  Value Codes:  J=$15,000 less  K=$15,00!-$50,000  L=$50,00I-$100,000  M=$100,001-$250,000  
(See Col. Cl, D3)  N=$250,001-$500,000  0=$500,001-$1,000,000  Pl=$1,000,00I-$5,000,000  P2=$5,000,001-$25,000,000  
P3=$25,000,001-$50,000,000  P4=More than $50,000,000  

Date Report 
5/9/2005 
VII. Page INVESTMENTS and TRUSTS --income, value, transactions (Includes those spouse and dependent children. See pp. 34-57of Instructions.) 

Date Report 
Name Person Reporting 
5/9/2005
Ambrose, Donetta 
VIII. ADDITIONAL INFORMATION EXPLANATIONS (Indicate part Report.)  Income/Gain Codes:  A=$1,000 less  B=$1,001-$2,500  C=$2,501-$5 ,000  D=$5,001-$15,000  
E=$ l5,001-$50,000  
(See Col. Bl, D4)  F=$50,001-$100,000  G=$100,001-$1,000,000  Hl=$1,000,001-$5,000,000  H2=More than $5,000,000  Value Codes:  J=$ 5,000 less  K=$15,001-$50,000  L=$50,001-$100,000  M=$100,001-$250,000  
(See Col. Cl, D3)  N=$250,00l-$500,000  0=$500,00I-$1,000,000  PI=$1,000,00I-$5,000,000  P2=$5,000,001-$25,000,000  
P3=$25,000,001-$50,000,000  P4=More than $50,000,000  

1 
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IX. CERTIFICATION. certify that all information given above (including information pertaining spouse and minor dependent children, any) accurate, true, and complete the best knowledge and belief, and that any information not reported was withheld because met applicable statutory provisions permitting non-disclosure. further certify that earned income from outside employment and honoraria and the acceptance gifts which have been reported are compliance with the provisions U.S.C. app.,  501 et. seq., U.S.C.  7353 and Judicial Conference regulations. 
Signature 
NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES FAILS FILE THIS REPORT MAYBE SUBJECT CIVIL AND CRIMINAL SANCTIONS U.S.C. App., 104.) 
FILING INSTRUCTIONS: 
Mail and additional to: Committee Financial Disclosure 
Administrative Office the 
United States Courts 
Suite 2-301 
One Columbus Circle, N.E. 
D.C. 20544