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AO 10 Rev. 1/2011
Report Required by the Ethics in Government Act of 1978 (5 U.S.C. app..~.~ 101-111)
US District Judge--Active
!D Initial
Quentin Burdick US Courthouse 655 1st Ave. N., Ste. 410 Fargo, ND 58102-4952
8. On the basis of the information contained in this Report and any modifications pertaining thereto, it is, in my opinion, in compliance with applicable laws and regulations.
Revie~ing Officer
Date
IMPORTANT NOTES: The instructions accompanying this form must be followed. Complete all parts, checking the NONE box for each part where you have no reportable information. Sign on last page.
NAME OF ORGANIZATION/ENTITY
II. AGREEMENTS. (Reporting individual only; see pp. 14-16 of filing instructions.)
D NONE (No reportable agreements.) DATE 1.1/15/88 2.2/I 5/93 3. 1/02/05 4. 12/31/96 401K Ohnstad Twichell, P.C. NDPERS County Retirement Plan NDPERS State Judicial Retirement Plan 457(b) Plan State of North Dakota
Erickson, Raloh R.
Ill. NON-INVESTMENT INCOME. (Reporting individual andspouse; seepp. 17-24 of filing instructions.)
A. Filers Non-Investment Income ~-~ NONE (No reportable non-investment income.) DATE SOURCE AND TYPE INCOME (yours, not spouses)
2.
3.
4.
B. Spouses Non-Investment Income - if you were married during any portlon of the repo~ting year, complete this section.
(Dollar amount not required except for honoraria.)
I. 12/31/2010 2. 3. 4.
NONE (No reportable reimbursements.) SOURCE DATES LOCATION PURPOSE ITEMS PAID OR PROVIDED
2. 3. 4. 5.
V. GIFTS. (Includes those to xpouse and dependent children; see pp. 28-31of filing inxtructions.) NONE (No reportable gifts.) SOURCE
I. 2. 3. 4. 5.
DESCRIPTION
VALUE
VI. LIABILITIES. a.ctude~ ,ho~o olspou~e and de~,e.de., children; see pp. 32-33 of filing instructionx)
NONE (No reportable liabilities.)
CREDITOR
I. 2.
DESCRIPTION
VALUECODE
3.
4. 5.
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; see pp. 34-60 of filing instructions.)
[~] NONE (No reportable income, assets, or transactions.)
A. Description of Assats (including trust assets) Place "(X)" after each asset exempt from prior disclosure B. Income during reporting period (I) (2) Type (e.g., Amount Code I div., rent, (A-H) or int.) C. Gross value at end of reporting period (I) Value Code 2 (J-P) (2) Value Method Code 3 (Q-W) (I) Type (e.g., buy, sell, redemption) D. Transactions during reporting period (2) Date mm/dd/yy (3) i (4) Value Gain Code 2 Code I (J-P) (A-H) ! (5) Identity of buyer/seller (ifprivate transaction)
I. 2.
Dividend None
J J
3. 4. 5. 6.
Intel, Inc., common stock Alcatel Lucent common stock Oakmark Select, mutual fund Proctor & Gamble, common stock Wells Fargo & Co., common stock
Dividend None
J J J J J M K K K
T T T T
A A A C A A A A A A
Dividend Dividend Dividend lnt./Div. Interest lnt./Div. Int./Div. Int./Div. lnt./Div. Interest None
8. 9.
~ Trust,B SEP IRA (No Investment Authority) Federated Capital Reserve Fund, State Bank & Trust (X) 401K ING Aetna 457(b) ING (Aetna) VP Index Plus Large Cap.
T T T T
II.
ING Aetna 457(b) Fidelity VIP Growth Portfolio 109 ING Aetna 457(b) T.Rowe Price MC Grlnit-449 ING Aetna 457(b) Oppenheimer Global PtInit--432
T J J M M W T T
14.
Gate City Savings-Savings Account Digital Broadcast Corporation Guardian Insurance Trust
Dividend Dividend
I, Income Gain Codes: (See Columns B I and D4 ) 2, Value Codes (See Columns C1 and D J) 3. Value Method Codes (Scc Column C2)
A =$1,000 or less F =$50,DO I - $ 100,DO0 J = $15.000 or less N =$250,001 - $SDO,DO0 P3 -$25.DO0,DO I - $50.000.000 Q =Appraisal U =Book Value
B =$1,001 - $2,500 G =$1 DO,DO I - $ I,DO0,DO0 K = $15.DO I - $ 50,DOO O =$500.001 - $1,000.DO0 R =Cost (Real Estate Only) V -Other
C =$2,501 - $5,000 H I = $ I,DO0,DO I - $5,DO0,0~ L -$ 50.001 - $ I DO,DO0 PI =$1.DO0.DOI - $5,DO0,000 P4 =More than $50.DOO.0DO S =Assessment W =Estimated
D =$5,001 - $15,000 H2 =More than $5,0DO.0DO M =$100,D01 - $250,DO0 P2 =$5,DO0.DOI - $25.000.000 T =Cash Market
E = $15,DO I - $50,DO0
VII. INVESTMENTS and TRUSTS - income, value, transactions (Includes those of spouse and dependent children; seepp. 34-60 of filing instructionx.)
NONE (No reportable income, assets, or transactions.)
Description of Assets (including trust assets) Place "(X)" after e~ch asset exempt from prior disclosure Income during reporting period Gross value at end of reporting period Transactions during reporting period
(O
Amount Code I (A-H)
(2)
Type (e.g., div., rent, or int.)
(1)
Value Code 2 (J-P)
(2)
Value Method Code 3
(1)
Type (e.g., buy, sell, redemption)
(5)
Identity of buyer/seller (if private transaction)
(Q-W)
18. 19. 20. 21. Guardian Insurance (Cash Value) Guardian Insurance (Cash Val~e) Guardian lnsurance (Cash Value) Jackson National Life ~ Life Insurance) D C A A Dividend Dividend Dividend Interest L K J K T T T T
I. Income Gain Codes: (See Columns BI and D4) 2. Value Codes (See Columns CI and D3) 3. Value Method Codes (see Column C2)
A =$1,000 or less F =$50,001 - $100,000 J =$15,000 or less N =$250.001 - $500,000 P3 =$25,000,001 - $50.009.000 Q =Appraisal U =Book Value
B =$1,0~1 - $2,500 G =$1~0,001 - 51,00~.0~) K =$15,001 - $50.000 O =$500,001 - $1,000.0~) R =Cost {Real Estate Only) V =Other
C =$2,501 - $5,000 H 1 =$1.00~,001 - $5.00~,0~0 L =$50.001 - $100.000 PI =$1.000,001 - $5,000,0~0 P4 =More than $50.000,0~1 S =Assessment W =E.-.timated
D =$5,091 - $15.0(~ H2 -More than $5.0~0.000 M =$10~.001 - $250.000 P2 =$5.000.001 - $25.000.0~0 I- =Cash Market
E :SIS,001 - $50.000
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 knowledge and belief, and that any information not reported ~vas withheld 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 svhich have been reported are in compliance with the provisions of 5 U.S.C. app. 501 et. seq., 5 U.S.C. 7353, and Judicial Conference regulations.
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 Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544