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Request For Examination Of Report Filed By A Judicial Officer Or Judicial Employee AO 10A - Official Federal Forms
| Request For Examination Of Report Filed By A Judicial Officer Or Judicial Employee Form. This is a national form and can be used in Administrative Office - Civil Federal District . |
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AO 10A (Rev 10/98) REQUEST FOR EXAMINATION OF REPORT FILED BY A JUDICIAL OFFICER OR JUDICIAL EMPLOYEE In accordance with section 105 of the Ethics in Government Act of 1978, as amended, I request that there be made available to me for examination the report(s) of the following named Judicial Officers or Judicial Employees: Copy Requested NAME NAMES OF REPORTS WHOSE DISCLOSURE REPORTS ARE REQUESTED POSITION Yes No ORGANIZATIONS OR PERSONS ON WHOSE BEHALF THIS REQUEST IS MADE ORGANIZATION(S) OR PERSON(S) ADDRESS I understand that the statute makes it unlawful to obtain or use this or these reports for: any unlawful purpose; any commercial purpose other than by news and communication media for dissemination to the general public; determining or establishing of the credit rating of any individual; or use, directly or indirectly, in the solicitation of money for any political, charitable, or other purpose (5 U.S.C. App. 4 § 105(c)) PROHIBITIONS I understand that whoever, in any manner within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact; makes any materially false, fictitious, or fraudulent statement or representation; or makes or uses any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both (18 U.S.C. § 1001). I am aware of the prohibitions on the obtaining and use of this information, as are stated above, and that this request for examination is a matter of public record. NAME PERSON ADDRESS OCCUPATION MAKING I certify under penalty of perjury that the foregoing is true and correct. (28 U.S.C. § 1746) REQUEST _______________________________________________ ___________________________________ SIGNATURE EXECUTED ON (DATE) American LegalNet, Inc. www.USCourtForms.com
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