AOIO Rev.. 112011 Report Required by the Ethics in Government Act of 1978 FOR CALENDAR YEAR 2010 (5 U.S.C. app. 101-111) Person Reporting (last name, first, middle initial) Court or Organization U. S. Court of Appeals 05/06/2011 Title (Article III judges indicate active or senior status; magistrate judges indicate full- or part-time) Circuit Judge-Active 7. Chambers or Office Address 300 N Hogan Street Suite 14-150 Jacksonville, FL 32202-4258 Sa. Report Type (check appropriate type) 6. Reporting Period D Nomination, Date 01/01/2010 D Initial [{ Annual D Final to 12/31/2010 Sb. Amended Report D 8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance ith applicable las and regulations. Revieing Officer Date IMPORTANT NOTES: The instructions accompanying this form must be folloed. Complete all parts, checking the NONE box for each part here you have no reportable information. Sign on last page. POSITI 0 NS. (Reporting individual only; see pp. 9-13 of filing instructions.) D NONE (No reportable positions.) POSITION NAME OF ORGANIZATION/ENTITY Trustee - Life Ins. Trust (Part VIII) I AGREEMENTS. (Reporting individual only; see pp.14-16 of filing instructions.) [{ NONE (No reportable agreements.) PARTIES AND TERMS
Page 2of8 05/06/2011 II N 0 N-INVESTMENT IN CO ME. (Reporting individual and spouse; see pp. 17-24 of filing instructions.) A. Filer's Non-Investment Income D NONE (No reportable non-investment income.) SOURCE AND TYPE INCOME (yours, not spouse's) 2010 Duke University School of La-appellate practice course $4 500.00, B. Spouse's Non-Investment Income - If you ere married during any portion of the reporting year, complete this section. (Doi/or amount not required except for honoraria.) D NONE (No reportable non-investment income.) SOURCE AND TYPE 2010 Self-employed president of travel agency 2010 Self-employed real estate broker 2010 Self-employed oner of limo service IV. REIMBURSEMENTS -transportation, lodging,food, entertainment. (Includes those to spouse and dependent children; see pp. 25-27 of filing instructions.) D NONE (No reportable reimbursements.) SOURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED Duke University Nov 14-16 2010 Durham, NC Teach Airfare, hotel, University of Florida Feb 3 2010 Gainesville, FL Roundtable Meals,
Page 3of8 05/06/2011 V. GIFTS. (Includes those to spouse and dependent children; see pp. 28-31 of filing instructions.) [{ NONE (No reportable gifts.) SOURCE DESCRIPTION VALUE V LIABILITIES. (Includes those of spouse and dependent children; see pp. 32-33 of filing instructions.) D NONE (No reportable liabilities.) CREDITOR DESCRIPTION VALUE CODE Bank of America Mortgage-Parcel 33 (Part VII, line 13) Pl SunTrust Bank Mortgage-Parcel 39 (Part VII, line 29) M Mercantile Bank Mortgage-Parcel 38 (Part VII, line 18) N
Page 4of8 05/06/2011 VI INVESTMENTS and TRUSTS D NONE (No reportable income, assets, or transactions.) - income, value, transactions (Includes those of spouse and dependent children; see PP 34-60 of filing instructions.) A. Description of Assets (including trust assets) Real Estate Parcel 2 Amelia Island, FL A Rent J Real Estate Parcel 5 Jacksonville, FL 0 Real Estate Parcel I 0 Jacksonville, FL c Rent J Wells Fargo IRA A Int./Div. Closed 01/27/10 K -Calamos Conv Opportunities & Income Fd Sold 01/21110 J 6. -DWS Investment Trust Capital Groth Fd ClB Sold 01/21/10 J 7. -Wells Fargo Bank Deposit Closed 01/27/10 K 8. -Evergreen Equity Tr Asset Allocation Fd Cl c Sold 01121110 K 9. Wells Fargo IRA J T 10. -Century Properties Fund XV LP 11. Real Estate Parce!ll Mars Hill, NC D Rent N 1 Real Estate Parcelll Jacksonville, FL D Rent L 1 Real Estate Parce!ll Orange Park, FL G Rent Pl 1 Loan-Plumlee A Interest J u 1 Real Estate Parceill Jacksonville, FL L 16. Loan-Smith 17. SunTrust account A Interest K T Income Gain Codes: A =$1,000 or less (Sec Columns BI and D4) F =$50,001 $100,000 Value Codes J =$15,000 or less (Sec Columns CI and D3) N =$250,001 -$500,000 P3 =$25,000,001 -$50,000,000 Value Method Codes Q =Appraisal (Sec Column C2) U =Book Value B =$1,001 $2,500 G =$100,001 -$1,000,000 K =$15,001 -$50,000 0 =$500,001 -$1,000,000 R =Cost (Real Estate Only) V =Other c =$2,501-$5,000 D =$5,001 -$15,000 E =$15,001-$50,000 HI =$1,000,00 I -$5,000,000 H2 =More than $5,000,000 L =$50,001 -$100,000 M =$I 00,001 '$250,000 Pl =$1,000,001 -$5,000,000 P2 =$5,000,001 $25,000,000 P4 =More than $50,000,000 S =Assessment T =Cash Market W =Estimated
Page 5of8 05/06/2011 VI INVESTMENTS and TR us TS D NONE (No reportable income, assets, or transactions.) - income, value, transactions (Includes those of spouse and dependent children; see PP 34-60 of filing instructions.) A. B. Description of Assets Income during (including trust assets) c. Place ''(X)" after each asset exempt fr Ill prior disclosure (1).Anioiil1t COdel A H) 18. Real Estate Parcel. Jacksonville, FL E Rent 0 19. Loan-S.K. Hong Inc D Interest L u Redeemed 07/16/10 L (par) 20. Loan-Smith 2 21. Loan-Bragg Closed 12/31/I 0 J 2 Loan-Heett 2 2 Loan-Norman 2 Loan-Norman 2 2 Loan-Lab Investments Closed 12/31/IO J 26. Loan-Forte D Interest L u 27. Compass Bank accounts A Interest J T 28. Mercantile Bank account A Interest J T 29. Real Estate Parceii1Jacksonville, FL M 30. Mid Atlantic Residential Investors LP J 31. Real Estate ParceillJacksonville, FL D Rent M 3 Real Estate ParceillJacksonville, FL D Rent L 3 Loan-Grum ling 3 Loan-Gibson c Interest K u J. Income Gain Codes: A =$1,000 or less B =$1,001 -$2,500 c =$2,501 -$5,000 D =$5,001 - $15,000 E =$15,001 -$50,000 (See Columns Bl and D4) F =$50,001 -$100,000 G =$100,001 -$1,000,000 HI =$1,000,001 -$5,000,000 H2 =More than $5,000,000 Value Codes J =$15,000or\ess K =$15,001 -$50,000 L =$50,00\ -$\00,000 M"'$100,001 -$250,000 (Sec Columns CI and D3) N=$250,00 1 -$500,000 0 =$500,001 -$1,000,000 Pl =$1,000,001 c $5,000,000?2=$5,000,001 - $25,000,000 P3 =$25,000,001 - $50,000,000 P4 =More than $50,000,000 Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S =Assessment T=Cash Market (Sec Column C2) U =Book Value V=Other W =Estimated
Page 6of8 05/06/2011 VI INVESTMENTS and TR us TS D NONE (No reportable income, assets, or transactions.) - income, value, transactions (Includes those of spouse and dependent children; see PP 34-60 of filing instructions.) 3 Loan-Gibson 2 A Interest K u 36. Bank of America account J T 37. Real Estate Parcel. Jacksonville, FL L 38. Loan-Black I D Interest 0 u 39. Loan-Black 2 D Interest 0 u 40. Real Estate Parcel. Jacksonville, FL K Buy 02/16/10 K RoryPire 41. l. Income Gain Codes: A =$1,000 or less 8=$1,001 -$2,500 C=$2,501 -$5,000 D =$5,001 - $15,000 E =$15,001 -$50,000 (See Columns Bl and D4) F =$50,001 -$100,000 G =$100,00l. $1,000,000 lll.;$1,000,001 -$5,000,000 H2 =More than $5,000,000 Value Codes J =$15,000 or less K =$15,001 -$50,000 L =$50,001 -$100,000 M =$100,001 -$250,000 (See Columns CI and D3) N =$250,00I - $500,000 0 =$500,001 -$1,000,000 Pl =$1,000,001 -$5,000,000 P2=$5,000,00I -$25,000,000 P3 =$25,000,001 - $50,000,000 P4 =More than $50,000,000 Value Method Codes Q =Appraisal R =Cost (Real Estate Only) S-=Assessment T =Cash Markel (See Column C2) U =Book Value V =Other W =Estimated
Page 7of8 05/06/2011 VII ADDITIONAL INFORMATION OR EXPLANATIONS. (lndicatepartofreport.) Part I Life Insurance Trust - not listed in Part VII, as it is an unfunded trust.
Page 8of8 05/06/201 I IX. CERTIFICATION. I certify that all information given above (including information pertaining to my spouse and minor or dependent children, if any) is accurate, true, and complete to the best of my knoledge and belief, and that any information not reported as ithheld because it met applicable statutory provisions permitting non-disclosure. I further certify that earned income from outside employment and honoraria and the acceptance of gifts hich have been reported are in compliance ith the provisions of 5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations. Signature: s/ Susan H. Black NOTE: ANY INDIVIDUAL WHO KNOWINGLY AND WILFULLY FALSIFIES OR FAILS TO FILE THIS REPORT MAY BE SUBJECT TO CIVIL AND CRIMINAL SANCTIONS (5 U.S.C. app. 104) Committee on Financial Disclosure Administrative Offce of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544