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FINANCIAL DISCLOSURE REPORT

FOR CALENDAR YEAR 2009
2. Conrt or Organization U.S. Court of Appc:ds Sa Report Type [chcck appr~priatc ~yp) ~ Nomination. ~ In,tial Da~ ~ Annual ~ Final

~.~ u.sc. ,I,p ~,".~" ~o~-~ll~

3. Date of Rrport 05~06,2010 6. Reporting Period 01,01,2009 12/31/2000

I. Person Reporling (la.~t name, first, middle initial} 13lack. Susan H. 4. Title (Article llI judgcs indicate active or scnior status; magistrate judges indical Ihll- at pad-dine) Circuit Jadgo-Acdv

7. Chambers or Office Address 300 N Hogan Street Suite 14-150 Jacksonville, FL 32202-4258

Sb. ~ Amended 8. On the basis of~he information contained in ~hls Rtpo~ and any modifications pe~aialng therelo, It is, In my opinion, In compliance ~l~h applicable law~ and regulations. Reviewing Officer Date

IMPORTANT NOTES: The instraction$ accompanying this form must be followe,~ Complete all parts,
checking the NONE box for each part where you have no reportable information. Sign on last page.

I. POSITIONS. m,~ora~x toa~ta~ot o~t~; ,,, vv. ~.l~ o~~ti,~ t~s~r~,,to,~)

D NONE (No reportable positions.) POSITION
I. Trustee

NAME OF ORGANIZATION/ENTITY
~ Life Ins. Trust {Part VIII)

[-~

NONE (No reportable agreements.) DATE PARTIES AND TERMS

Black, Susan H.

Name of Person Reporting

Date of Report

PageFINANCIAL2 of 8 DISCLOSURE REPORT

a ack, Susan 11.

05,062010

IIl. NON-INVESTMENT INCOME. tRepora,~,~h,ld,,=tond.~p ..... .-,e, pp.

A. Fliers Non-lnvestment Income
NONE (No reportable non-investment income.) DATE

SOURCE AND TYPE __

Duke University School of Law-appelhte practice course Florida State University College of Low -jurist-in-resldence

(yours, not spouses) $4,500.00 $2,000.00

1. 2009 2. 2009 3. 4.

B. Spouses Non-Investment Income - if you were married daring any portion of the reporting year, complete thls secttott
(Dollar amotttff not required xcept fi~r honoraria.)

[~

NONE (No reportable non-investment income.) DATE SOURCE AND TYPE

Self-employed president of travel agency Self-employed real estate broker Self-employed owner of llmo service

I. 2009 2. 2009 3. 2009 4.

IV. REIMBURSEMENTS - t~..,,~onaa,,n, toa~.t,/oo,t, ..,..,a,,m.n"

(lnclude~ tlu,se to spmtse and dependent children: see pp. 25-27 offili~ i~rructions.)

NONE (No reportab& reimbursements.) ~ ~

Jun 25, 2009 Sep 20-22, 2009 Nov 15-17, 2009

LOCATION
Orlando, FL Tallahass~, FL Durham, NC

PURPOS~
Roundtable Teach Teach

ITEMS PAID OR PROVIDED

Mileage, meal Mileage, meals, hotel Hotel

1. 2. 3. 4. 5.

The Florida Bar Florida State University Duke Uaive~ity

FINANCIAL DISCLOSURE REPORT

Page 3 of 8

N.me of Person Reporting

Da,r of Report

m.k, Susan tl.

05/06,2010

NONE (No reportable g~fis.) ~ DESCRIPTION VAL~

1. 2. 3.

5.

Vl. LIABILITIES. (Indudes those of sp ......

~ NONE (No reportable liabilitiesO CREDITOR
1. 2. 3. 4. 5. Bank of America SunTrust Bank Mercantile Bank PHH Moagage Coldwell Banker Moagage

a d~enaent ct, ildrtne s~. 32-33 0f filing instructlonsd

~
Mongage-Parcel 33 (PaR VII, line 18) Mortgage-Pared 39 (Paa VII, line 36) Mortgage-Parcel 38 (Pa~ VII, line 25) Mo~gage-Parcel 40 (Pa~ VII, line 38) Mortgage-Parcel 41 (Pan VII, line 39)

~
PI M N M L

Name of Person Reporting

Date of Itcport

PageFINANCIAL4 of" 8 DISCLOSURE REPORT

alack. Susan n.

0~,0~,20 tO

NONE (~Vo reportable income, assets, or transactions.)

D~cr;ption of As~ts ~i~.luding tn~st assets) Pl~e "{XF afl~ each ~sct exempt from prior disclosure I~ome d~ing tepo~ing period 11) (2) Amount Type (e.g., C~ I div., rent, {A-H) or int.) Gross value at end . vfrcpoaing period : 11) (2) Value Value C~ 2 Mc~ C~e 3 (J.P} (Q.%~ J O M W W W Transactions during rcponlng . "(I) ....... (2) O) (~ ....... Date Value Gain Ty~ ~c.g., buy, sell, mnx~d~yy . Code 2 Code I ~dcmption) {I-P) (A-Ill (5) .... Identity buyerseller (if prigate transaction)

I. 2, 3. 4. 5. 6. 7. 8. i 9. 10. I I. 12. 13. 14. 15. 16. 17.

Real Estate Parcel 2 Amelia Island, FL Real Estate Parcel 5 Jac~onville, FL Real Estate Parcel I 0 Jacksonville, FL Real Estate Parcel 13 Jacksonville, FL (Y) Wells Fargo IRA (formerly Wachovia) -Calamos Conv Opportunities & Income Fd .DWS Investment Trust Capital Growth Fd CI B -Wells Fargo Bank Deposit (formerly Waehovia) -Evergreen Equity Tr Asset Allocation Fd CI C Wells Fargo IRA (formerly Wachovia) -Evergreen Equity Tr Asset Allocation Fd CI C -BIackrock IncomeTmst Inc -Wells Fargo Bank Deposit (formerly Wuchovla) -Ca]amos Strategic Total Return Fd -Ceatu~ Properties Fund XV LP Real Estate Parcel 29 Mars Hill, NC Real Estate Parcel 31 Jacksonville, FL

Rent Non~ None

Int./Div.

Int./Div,

T Sold Sold Closed Sold 01/20/09 01/20/09 01/20/09 01120/09 K J L J

C A

Rent Rent

N M

W W

3 Value Mctht~ Co~s

Q =Apprai~l

R ..Co~ tReal Estate Only]

S -Assg~gmenl

T ~ash Market

FINANCIAL DISCLOSURE REPORT

N,me of
Black, Susan II.
I 05,O6/2010

Page 5 of 8
VII. I1NVESTMENTS and TRUSTS - ~ ........ ,.t.~,

NONE (No reportable income, assets, or transactions.) A, Dcscription of Assets [including[rust a~cts) PIace "[X)" after each asset exempt from pdor disclosure B. Income during rclmrtingpcriod II) ~ (2) Amount . Type (.g., Code I div., rent, (A-H) ! or int.) : l G
A

c. Gross value at end i of reporting period i Value I Code 2 ~. (J-P) T)pc (e.g.. Value Mcd,od buy, sell, Code 3 : rcdcmption} (Q-W) . J.. W
U

D. Transactions during reporting period

! Date !Valuc Gain mm,dd;yy i Code 2 :; Code I (J-P) (A-H) i l :..

Identity of buyer/seller [if private Iransaction)

18.
19.

Real Estate Parcel 33 Orange Park, FL

Loaa-Plumlee

Rent
Interest

Pl
J

20.

Real Estate Parcel 34 Mt Pleasant. IA

Rent

Sold

02/01/09 O

Leigh Black

21. 22.
23. 24. 25. 26.

Real Estate Parcel 35 Cocoa, FL Real Estate Parcel 37 Jacksonville, FL

Loan-Smith Sunrrust accounts Real Estate Parcel 38 Jacksonville, FL Lom-S.K. Hong lnc E A

None None
None Interest None Interest

Sold L
J J O M

02/01/09

Leigh Black

W
U T W U

27.
28. 29. 30. 3I. 32 33. 34.

Loan-Smith 2
Loan-Bragg Loan-Hewntt 2 Loan-Norman Loan-Norman 2 Loan-Lab Investments Loan-Forte Con~pass Bank accounts D D

None
None None None None Interest Interest None

K
J K J J M L J

U
U U U U U U T

PJ ~ $25,~,~1 $50,~.~ l S~ Column C~) U "B~k Value V -(~hcr

P4 =Mare than W =Esti~led

FINANCIAL DISCLOSURE REPORT Page 6 of 8

N,m, of Person Reporting Black, Susan tl.

Date of Report 05.06/2010

NONE (No reportable income, assets, or transactions.)

Description of Assets tincluding trust assc~s) Place(X)"af~creach asxct exempt from prior disclosure ~ Income durin~ ~. .............. reporting period Amout~l ! Type(e.g., i Code I , div., rent, (A-H) *~ or int.) : Gross value at end . of rcportirtg period Value Code 2 (J-P) Value Method Code 3 (Q-W) Type (e.g., buy, sell. redcmption) Transactions during reporting period

. [

Value Gain Date mm,dd/yy " Code 2 Code I (A-Ill t (JP) I ;

Identity of bu,,er,sller (if private transaction)

35.

Mercantile Bank accounts

Interest

36. 37. 38. 39. 40. 41. 42. 43. 44, 45. 46. 47.

Real Estate Parcel 39 Jacksonville, FL Mid Atlantic Residential Investors LP Real Estate Parcel 40 Jacksonville. FL Real Estate Parcel 41 Jacksonville, FL Loan-Grumling Loan-Gibson Loan-Gibson 2 Bank of America accounts Real Estate Parcel 42 lacksonville. FL Loan-Black I Lo~-Black 2 D D C B B D D

None Distribution Rent Rent None Interest Interest None None Interest Interest

M J M L J K K J M O O

W W W W U U U T W U U Open Open 02/01109 O 02/01109 O

A I Income GainCodcs: ..... =$l.00Oor less F ,$50.~1 - $100,~0 (Sc Cl~lu~s 131 and D4) J "$15,0~ or less 2 Value Cries N ,-1250.~1 55~.0~ t~e Cola,n~s C I and D3} P3 =$25.~.~! $50.~1).~ J Vah~ Nt~h~ Codes Q =Appmis*l U ~k Valtg {See Cohann C2)

B.-$1,0~1. $2.J00" G -$1~,~1 $1 .~.0t~ K ... I 15.~ I - $~.~ O =15~.~1 - $1 .~.~ R -Ct~ (Real Estate Only) V - Ot~r

C ~$2.~01- S5,0~ I II -~il.~.~l - SL~,~ L ~,$50,~ I - $ I ~.~ P t ".~$1,~).~1 $5,~.~0 P4 "*Mo~ than S =Assessment W .~Estimatcd

D,,$J,~I-$1~.~ 112 =Morn than M :~$ 100,1~ I - $ 2 P2 =$5.~.001 T =Cash Market

E=$15,~1 - $50.0~

FInAnCIAL DISCLOSURE REPORT Page 7 of 8

.~ame of person Repnrlln~

Date o~ Report

~ ~ck, s~ ~.

VIII. AI)DITIONAL INFORMATION OR EXPLANATIONS. et, dl, a~ep,,,

Pan I - ~ Life Insurance Trust - not listed in Part VII, as it is an unfunded ~rust.

FINANCIAL DISCLOSURE REPORT Page 8 of 8

IX. CERTIFICATION.

I
! [ Black, Susan ll. I

05.06/2010

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 an) information not reported was withheld because It met applicable statUtory provlsion~ permitting non-disclosure. I further certify that earned income from outside employment and honoraria and the acceptance of gifts which 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 W[LFULLY FALSIFIES OR FALLS TO FILE TillS REPORT MAY BE SUBJECT TO CIVIL AND CRIh~INAL SANCTIONS (5 U.S.C. app. 104}

FILING INSTRUCTIONS Mail signed original and 3 additional copies to: Committee on Financial Disclosure Administrative Office of the United States Courts Suite 2-301 One Columbus Circle, N.E. Washington, D.C. 20544