Cindy K. Jorgenson – 2011
Category:Federal Judges
Number of Pages:6
Date Created:February 26, 2013
Date Uploaded to the Library:November 06, 2014
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POSIT! ONS. (Reporting individual only; see pp. 9-13 filing instructions.) [{] NONE (No reportable positions.) POSITION NAME ORGANIZATION/ENTITY II. AGREEMENTS. (Reporting individual only; see pp. 14-16 filing instructions.) NONE (No reportable agreements.) PAR TIES AND TERMS 2010 Arizona Elected Officials Retirment Plan, control Date Report 04/25/2012 Jorgenson, Cindy III. N-INVESTMENT ME. (Reporting individual and spouse; see pp. 17-14 filing instructions.) Filers Non-Investment Income NONE (No reportable non-investment income.) SOURCE AND TYPE INCOME (yours, not spouses) 2011 Arizona Elected Officials Retirement Plan $25,194.00 Spouses Non-Investment Income -If you were married during any portion the reporting year, complete this section. (Dollar amount not required except for honoraria.) NONE (No reportable non-investment income.) SOURCE AND TYPE 2011 Arizona Public Safety Retirement System (Retired) 2011 Arizona State Retirement System IV. REIMBURSEMENTS -transportation, lodging, food, entertainmenL (Includes those spouse and dependent children; see pp. 25-27 filing instructions.) [{] NONE (No reportable reimbursements.) SOURCE DATES LOCATION PURPOSE ITEMS PAID PROVIDED GIFTS. (Includes those spouse and dependent children; see pp. 28-31 filing instructions.) [Z] NONE (No reportable gifts.) SOURCE DESCRIPTION VALUE VI. LIABILITIES. (Includes those spouse and dependent children; see pp. 32-33 filing instructions.) [Z] NONE (No reportable liabilities.) CREDITOR DESCRIPTION VALUE CODE Date Report 04/25/2012 Jorgenson, Cindy VII. INVESTMENTS and TRUSTS -income, value, rransacrions r1nc1udes 11rose spouse and dependent children; see PP. 34-60 instructions.) NONE (No reportable income, assets. transactions.) Description Assets Income during Gross value end Transactions during reporting period (including trust assets) reporting period reporting period (I) (2) (2) (2) (3) (5) Place {X) after each asset Amount Type (e.g., Value Value Type (e.g., Date Value Gain Identity exempt from prior disclosure Code div., rent, Code2 Method buy, sell, mm/dd/yy Code2 Code buyer/seller (A-H) int.) (J-P) Code redemption) (J-P) (A-H) (if private (Q-W) transaction) Income Gain Codes: =$1,000 less B=$1.00t -$2.500 =$2.501 $5.000 D=$5.00t -$15.000 =$15.001 -$50.000 (Sec Columns and D4) =$50.001 -$100.000 =$100.001 -$1.000.000 Ill =$1.000,001 -$5.000.000 112 =More than $5.000.000 Value Codes =$15.000 less =$15.001 -$50.000 =$50.00I -$I 00.000 =$100.00 -$250.000 (Sec Columns and DJ) =$250.00 -$500.000 =$500.00 -$1.000.000 =$1.000.001 -$5.000.000 =$5,000.001 -$25.000,000 =$25.000.001 $50.000.000 =More than $50.000.000 Value Method Codes =Appraisal =Cost (Real Estate Only) =Assessment =Cash Market (Sec Column C2) =Book Value V:oOthcr =Estimated Date Report 0412512012 Jorgenson, Cindy VIII. ADDITIONAL INFORMATION EXPLANATIONS. (lndicalepartofreport.) Date Report Jorgenson, Cindy 04/25/2012 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 ct. seq., U.S.C. 7353, and Judicial Conference regulations. Signature: Cindy Jorgenson NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILLFULLY FALSIFIES FAILS FILE THIS REPORT MAY SUBJECT CIVIL AND CRIMINAL SANCTIONS U.S.C. app. 104) Committee Financial Disclosure Administrative Office the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544