AO10A, Request for Examination of Report Filed by a Judicial Officer or Judicial Employee
Requesting the examination of a reporting that has been filed by a judicial officer requires the use of the following application form.
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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 o\
f 1978, as amended, I request that there be
made available to me for examination the report(s) of the following na\
med Judicial Officers or Judicial Employees:
NAME POSITIONCopy Requested
Yes No
NAMES
OF
REPORTS WHOSE
DISCLOSURE REPORTS
ARE
REQUESTED
ORGANIZATIONS OR PERSONS ORGANIZATION(S) OR PERSON(S)
ADDRESS
ON WHOSE
BEHALF THIS
REQUESTIS MADE
PROHIBITIONS 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 di\
ssemination to the general
public; determining or establishing of the credit rating of any individu\
al; 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))
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, fictitiou\
s, or fraudulent statement or
representation; or makes or uses any false writing or document knowing t\
he 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 informat\
ion, as are stated above, and that this
request for examination is a matter of public record.
PERSON NAME
ADDRESS
MAKING OCCUPATION
REQUEST I certify under penalty of perjury that the foregoing is true and corre\
ct. (28 U.S.C. § 1746)
_______________________________________________ _______________\
____________________
SIGNATURE EXECUTED\
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