Nevada > Statewide > Administrative Office Of The Courts
Judicial Financial Disclosure Statement - Nevada
| Judicial Financial Disclosure Statement Form. This is a Nevada form and can be used in Administrative Office Of The Courts Statewide . |
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STATE OF NEVADA JUDICIAL STATEMENT OF FINANCIAL DISCLOSURE INSTRUCTIONS 1. This statement is to be filed as a public document with the Administrative Office of the Courts. Submit an original and one copy of the judicial statement of financial disclosure to the Administrative Office of the Courts, 201 South Carson Street, Suite 250, Carson City, Nevada 89701-4702. The State Court Administrator will return a file-stamped copy to you. Please type or print all information. (A fillable pdf of the Judicial Statement of Financial Disclosure can be found on the Supreme Court website. www.nevada judiciary.us) If additional sheets are necessary to complete this form, attach them to the statement and label the information with the corresponding question number from the statement. If there is no information to be disclosed, type or print "None" in the appropriate space. Provide information for the calendar year immediately preceding the filing deadline for the report. This statement is to be filed by judges. A judge, within the meaning of the Nevada Code of Judicial Conduct, is anyone who is authorized to perform judicial functions, including an officer such as a magistrate, court commissioner, special master, or referee. Administrative law judges and hearing officers of state agencies are NOT judges within the meaning of the Code. This statement is to be filed on or before March 31 for the preceding calendar year of a judge's term, unless required by the Nevada Code of Judicial Conduct to be filed at an earlier date. With prior notification to the representative listed below, the Judicial Statement of Financial Disclosure be filed via telefax. Once you contact the representative, you will be given the appropriate fax number to use. The original document must be submitted to the State Court Administrator within three judicial days of the date of telefax filing. Please direct any questions regarding the filing of this form to Cynthia Sampson at (775) 684-1744. 2. 3. 4. 5. 6. 7. 8. 9. (Rev. 1/5/12) American LegalNet, Inc. www.FormsWorkFlow.com JUDICIAL FINANCIAL DISCLOSURE STATEMENT FOR YEAR ENDING DECEMBER 31, 20 GENERAL INFORMATION 1. Name 2. Title 3. Mailing Address 4. Length of residence in Nevada 5. County in which you are registered to vote 6. Length of residence in the county in which you are registered to vote COMPENSATION FOR EXTRA-JUDICIAL ACTIVITIES 7. Judges, and not their spouses or domestic partners, must disclose the date, place, and nature of any extra-judicial activity for which you received compensation, the name of the payor, and the amount or value of the compensation so received. See Code of Judicial Conduct Rule 3.15 (A)(1). NRS 281A.070 defines compensation to mean, "any money, thing of value or economic benefit conferred on or received by any person in return for services rendered, personally or by another." Attach additional sheets if necessary. Date Nature and Place of Activity Name of Payor Amount (Rev. 1/5/12) FINANCIAL DISCLOSURE STATEMENT - PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com GIFTS, BEQUESTS, FAVORS, OR LOANS 8. Judges, and not their spouses or domestic partners, must disclose the date, place, name of the donor, amount, and nature of any gift, bequest, favor or loan to you if its value exceeded $200. See Code of Judicial Conduct Rule 3.15(A)(2). In completing this section, please review all provisions of Code of Judicial Conduct Rule 3.13. Attach additional sheets if necessary. Date Name and Place of Gift Name of Donor Amount 9. Disclose the date, reimbursement of expenses or waiver of fees or charges on your behalf or on behalf of your spouse, domestic partner, or guest if its value exceeded $200. See Code of Judicial Conduct Rule 3.15(A)(2). In completing this section, please review all provisions of Code of Judicial Conduct Rule 3.14. Attach additional sheets if necessary. Date Fees or Charges Waived or Expenses Reimbursed Source of Reimbursement or Waiver Amount I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS DOCUMENT IS TRUE AND COMPLETE Date File this form with the State Court Administrator Deliver or mail to: State Court Administrator Attn: Cynthia Sampson Administrative Office of the Courts 201 S. Carson Street, Suite 250 Carson City, Nevada 89701-4702 Telephone: (775) 684-1744 Signature (Rev. 1/5/12) FINANCIAL DISCLOSURE STATEMENT - PAGE 3 American LegalNet, Inc. www.FormsWorkFlow.com
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