Hawecker et al v. Sorensen

Filing 183

ORDER APPROVING Consent Decree 182 , signed by Magistrate Judge Jennifer L. Thurston on 9/13/2012. (Hall, S)

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STEVEN H. ROSENBAUM
R. TAMAR HAGLER (SBN 189441)
COLLEEN M. MELODY
PAMELA O. BARRON
United States Department of Justice
950 Pennsylvania Avenue NW
Washington, DC 20530
[phone]
BENJAMIN B. WAGNER
ALYSON A. BERG
United States Attorney’s Office, Eastern District of California
2500 Tulare Street, Suite 4401
Fresno, CA 93721
[phone]
Attorneys for Plaintiff United States of America
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF CALIFORNIA
FRESNO DIVISION
CARRIE HAWECKER and MICHELLE
BROUSSARD, individually and on behalf of a
class of similarly situated persons;

)
)
)
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Plaintiffs,
)
vs.
)
)
RAWLAND LEON SORENSEN,
)
)
Defendant.
)
__________________________________________)
__________________________________________
UNITED STATES OF AMERICA,
)
)
Plaintiff,
)
)
vs.
)
)
RAWLAND LEON SORENSEN,
)
)
Defendant.
)
__________________________________________)

Case No. 1:10-cv-00085-JLT

Case No. 1:11-cv-00511-JLT

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Consent Decree

CONSENT DECREE

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I. INTRODUCTION

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1.

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This action was filed on January 15, 2010, by Carrie Hawecker and Michelle Broussard
(“Private Plaintiffs”) against Defendant Rawland Leon Sorensen (“the Defendant”)

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alleging violations of the Fair Housing Act, as amended, 42 U.S.C. §§ 3601–3631, as

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well as violations of California state law.

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2.

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On March 25, 2011, a separate action was filed by the United States to enforce the Fair
Housing Act. The United States alleges that the Defendant has engaged in a pattern or

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practice of resistance to the full enjoyment of rights granted by the Fair Housing Act, and

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denial to a group of persons of the rights granted by the Fair Housing Act which denial

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raises an issue of general public importance.

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3.

Specifically, the United States and the Private Plaintiffs allege that, at least from 2002
through the present, the Defendant on multiple occasions subjected actual and
prospective female tenants of his rental properties to discrimination on the basis of sex,

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including severe, pervasive, and unwelcome sexual harassment. Such conduct has

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included, but is not limited to:

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a. Making unwelcome sexual advances and unwelcome sexual comments to female

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tenants and prospective tenants;

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b. Exposing his genitals to female tenants and prospective tenants;
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c. Entering the residences of female tenants without permission or notice;

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d. Groping or otherwise touching female tenants on their breasts and buttocks

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without their consent;

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Consent Decree

e. Granting or offering to grant tangible housing benefits—such as reducing the rent,

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overlooking or excusing late or unpaid rent, purchasing new appliances for the

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rentals, and forestalling or terminating eviction proceedings—in exchange for sexual

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favors; and

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f. Taking adverse housing actions against female tenants who have not granted or who

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would not continue to grant the requested sexual favors, including evicting or

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initiating eviction proceedings against such tenants in retaliation against them.

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4.

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By the actions and statements described above, the United States and the Private
Plaintiffs allege that the Defendant has:

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a. Denied housing or otherwise made a dwelling unavailable because of sex in violation

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of 42 U.S.C. § 3604(a);

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b. Discriminated in the terms, conditions, or privileges of rental of a dwelling, or in the

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provision of services or facilities in connection therewith, because of sex, in violation

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of 42 U.S.C. § 3604(b);

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c. Made statements with respect to the rental of a dwelling that indicate a preference,

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limitation, or discrimination based on sex, in violation of 42 U.S.C. § 3604(c); and

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d. Coerced, intimidated, threatened, or interfered with a person in the exercise or

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enjoyment of, or on account of their having exercised or enjoyed, their rights granted

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or protected by Section 804 of the Fair Housing Act, in violation of 42 U.S.C. § 3617.
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5.

The United States further alleges that the conduct of the Defendant constitutes:
a. A pattern or practice of resistance to the full enjoyment of rights granted by the Fair
Housing Act under 42 U.S.C. § 3614(a); and

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Consent Decree

b. A denial to a group of persons of the rights granted by the Fair Housing Act, which

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denial raises an issue of general public importance under 42 U.S.C. § 3614(a).

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6.

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The United States and the Private Plaintiffs allege that female tenants, prospective
tenants, and persons associated with them have been injured by the Defendant’s

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discriminatory conduct. Such persons are aggrieved persons as defined in 42 U.S.C.

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§ 3602(i) and have suffered damages as a result of the Defendant’s conduct.

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7.

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The United States and the Private Plaintiffs allege that the Defendant’s conduct was
intentional, willful, and/or taken in reckless disregard for the rights of others.

8.

On April 22, 2011, the Court consolidated the actions by the United States and the

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Private Plaintiffs.

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9.

By their signatures below, the parties hereby consent to the entry of this Consent Decree

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and the attached Judgment.

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ACCORDINGLY, it is hereby ADJUDGED, ORDERED and DECREED:

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II. GENERAL INJUNCTION

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10.

The Defendant, his agents, employees, successors and assigns, and all other persons in

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active concert or participation with them, are enjoined, with respect to the rental of

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dwellings, from:

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a. Refusing to rent a dwelling unit, refusing or failing to provide or offer information

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about a dwelling unit, or otherwise making unavailable or denying a dwelling unit to
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any person because of sex;

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b. Discriminating against any person in the terms, conditions or privileges of renting a

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dwelling unit, or in the provision of services or facilities in connection therewith,

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because of sex;

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Consent Decree

c. Making, printing, publishing, or causing to be made any notice, statement or

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advertisement with respect to the rental of a dwelling unit that states any preference,

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limitation or discrimination based on sex; or

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d. Coercing, intimidating, threatening or interfering with any person in the exercise or

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enjoyment of, or on account of having exercised or enjoyed, or on account of having

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aided and encouraged any other person in the exercise or enjoyment of, any right

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granted by the Fair Housing Act.

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III. INDEPENDENT MANAGER(S)
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The Defendant may retain ownership of the rental properties located at 3209 Oregon

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Street, 3226 Oregon Street (aka 1401 Vale Street), and 8905 Viola Street, all in

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Bakersfield, California (the “Subject Properties”). The Defendant has represented that at

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least one of the Subject Properties will continue to be operated as a residential rental

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property and that, after conveying his interest in the properties identified in paragraph 36

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and Appendix A, he will have no remaining financial or other interest in any other

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residential rental property.

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12.

The Defendant shall retain or otherwise enter into an agreement with an individual or

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individuals, approved in advance by the United States (hereinafter “Independent

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Manager(s)”), to manage all aspects of the rental and management of the Subject

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Properties. The Defendant must, within fifteen (15) days after the entry of this Consent
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Decree, identify a proposed Independent Manager(s) who is unrelated to him and who

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does not now work for him, and has not in the past worked for him, as a contractor or in

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any other capacity. The United States will have fifteen (15) days following the

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Defendant’s identification of a proposed Independent Manager(s) to notify the Defendant

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Consent Decree

whether the Independent Manager(s) has been approved. If the United States does not

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approve the proposed Independent Manager(s), the Defendant will have fifteen (15) days

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from such notification to identify an alternate Independent Manager(s). This process will

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continue until an Independent Manager(s) is approved by the United States and,

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immediately thereafter, formally retained by the Defendant.

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13.

If after retaining the Independent Manager(s) the Defendant wishes to change

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Independent Manager(s), the Defendant may do so, provided that any such subsequent

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Independent Manager(s) must also be approved in advance by the United States and

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comply with the requirements in this Consent Decree.

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14.

The Independent Manager(s) shall maintain a place of business other than the

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Defendant’s personal residence. No tenant shall be requested or required to go to the

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Defendant’s personal residence to transact business related to his or her tenancy.

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15.

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Only the Independent Manager(s) shall be responsible for showing and renting units,
supervising repairs, determining whom to rent to and/or evict, overseeing all aspects of

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the rental process, and engaging in any other management activities. The Defendant may

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consult with the Independent Manager(s) to set general policies related to rent payments,

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evictions, and other matters, but may not be involved in individualized decisions specific

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to any particular tenant.

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16.

Within ninety (90) days of the entry of this Consent Decree, the Defendant, the

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Independent Manager(s), and any person involved in showing, renting or managing any

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dwelling unit, shall undergo in-person training on the Fair Housing Act, with specific

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emphasis on discrimination on the basis of sex. The training shall be conducted by an

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independent, qualified third party, approved in advance by the United States, and any

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Consent Decree

expenses associated with this training shall be borne by the Defendant. The Defendant

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shall obtain from the trainer certifications of attendance, executed by each individual who

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received training, confirming their attendance. This confirmation shall include the name

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of the course, the name of the instructor, the date the course was taken, and the length of

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the course and/or time within which the course was completed. At a minimum, the

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training required shall consist of instruction on the requirements of all applicable federal

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and state housing discrimination laws, with an emphasis on sexual harassment, and a

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question and answer session for the purpose of reviewing the foregoing areas.

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17.

The Independent Manager(s) shall be responsible for:

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a. Distributing the pamphlet entitled “Are You a Victim of Housing Discrimination?”

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(Department of Housing and Urban Development (HUD) Form 903.1) to all

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applicants and tenants at the Subject Properties;

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b. Whenever any of the Subject Properties is available to rent, posting a prominent,
easily readable “For Rent” or “Vacancy” sign or notice at each such property; the sign

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shall include the slogan “Equal Housing Opportunity” and/or the fair housing logo;
c. Posting and prominently displaying an 8.5-by-11-inch HUD fair housing poster

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(HUD Form 928.1) in a conspicuous location in or near the rental office or other

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location used as a rental office for the Subject Properties;

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d. Requiring that all advertising conducted in newspapers, telephone directories, radio,
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television or other media, and all billboards, signs, pamphlets, brochures and other

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promotional literature, be in compliance with HUD advertising guidelines, available

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on the HUD website, www.hud.gov/offices/fheo/library/part109.pdf.

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Consent Decree

e. Ensuring that any and all employees who will be performing any duties in relation to

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the Subject Properties are familiar with the requirements of the Fair Housing Act,

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particularly as they pertain to sex discrimination and sexual harassment;

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f. Notifying the United States in the event the Independent Manager(s) obtains any

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information indicating that the Defendant is in violation of this Consent Decree or the

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Fair Housing Act, including by entering the premises of any of the Subject Properties

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without first complying with the requirements of paragraph 19, below;

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g. Providing to the United States notification and documentation 1 of the following

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events, no later than fifteen (15) days after occurrence:

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i. Any change in the Defendant’s rules or practices regarding the Nondiscrimination

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Policy discussed in section IV, below, or the nondiscriminatory standards and

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procedures discussed in section V; and

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ii. Any written or oral complaint against the Defendant, or the Defendant’s agents or

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employees, regarding discrimination in housing. If the complaint is written, the

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Independent Manager(s) shall provide a copy of it with the notification. The

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notification shall include the full details of the complaint, including the

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complainant’s name, address, and telephone number. The Defendant shall

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promptly provide the United States all information it may request concerning any

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such complaint and shall inform the United States within fifteen (15) days of the
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substance of any resolution of such complaint; and

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All documents or other communications required by this Consent Decree to be sent to the
United States shall be sent by commercial (non-USPS) overnight delivery service addressed as
follows: Chief, Housing and Civil Enforcement Section, Civil Rights Division, United States
Department of Justice, 1800 G Street, N.W., Suite 7002, Washington, D.C. 20006, Attn: DJ 17511E-183, or as otherwise directed by the United States. Facsimile transmissions shall be sent to
[phone].
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Consent Decree

h. Providing any information reasonably related to compliance with this Consent Decree

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that is requested by the United States.

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18.

Within ninety (90) days of the date of entry of this Consent Decree, and every six (6)
months thereafter for the duration of this Consent Decree, the Independent Manager(s)

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shall deliver to the United States a report containing information about the Defendant’s

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compliance efforts during the preceding reporting period, including but not limited to:

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a. A list of the Subject Properties, including the street address, the number of rental

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units at each property, and a description of the interest in the property;
b. A list of all tenants at the Subject Properties and their telephone numbers;

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c. Notification and documentation of the adoption and implementation of the

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Nondiscrimination Policy referred to in section IV, below, including copies of all

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Employee Acknowledgement forms;

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d. Notification and documentation of the adoption and implementation of the
nondiscriminatory standards and procedures discussed in section V, below;

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e. Copies of standard rental applications and leases, pursuant to paragraphs 21–22 of
this Consent Decree;
f. Copies of all fair housing training certifications, pursuant to paragraph 16 of this
Consent Decree;

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g. Copies of all rental applications, leases, and other information, recorded by any
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means, related to any inquiries regarding the availability of the Subject Properties,

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maintained pursuant to section V of this Consent Decree;

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h. Notification of any purchase, inheritance, acquisition, sale, transfer, disposition, or
other change in the Defendant’s ownership or management interest in any of the

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Consent Decree

Subject Properties, including the identity of the purchaser(s) to whom the interest is

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being transferred.

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The final report due under this paragraph shall be delivered to the United States sixty (60)

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days prior to the expiration of this Consent Decree.

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19.

The Defendant shall not enter the premises of any of the occupied Subject Properties

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except upon prior approval by the United States for an inspection with the Independent

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Manager(s). The Independent Manager(s) must accompany the Defendant to any such

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inspection and remain physically present on the premises at all times that the Defendant

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is on the premises of one of the Subject Properties.

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IV. NONDISCRIMINATION POLICY

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20.

The Defendant must implement, through the Independent Manager(s), the written

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Nondiscrimination Policy set forth in Appendix B. Within fifteen (15) days of being

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retained pursuant to paragraphs 12–13 of this Consent Decree, the Independent

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Manager(s) must implement the Nondiscrimination Policy and distribute it to all

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employees and agents who have responsibility for showing, renting, or managing any and

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all of the Subject Properties. The Independent Manager(s) shall secure a signed

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statement from each such agent or employee acknowledging that he or she has received

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and read the Consent Decree and the Nondiscrimination Policy, has had the opportunity

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to have questions about the Consent Decree and Nondiscrimination Policy answered, and
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agrees to abide by the relevant provisions of the Consent Decree and the

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Nondiscrimination Policy. This statement shall be in the form of Appendix C.

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V. NONDISCRIMINATORY STANDARDS AND PROCEDURES FOR
SHOWING AVAILABLE DWELLING UNITS TO PROSPECTIVE TENANTS

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Consent Decree

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21.

Within thirty (30) days of the United States’ approval of the Independent Manager(s), the

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Independent Manager(s) shall develop and implement, with respect to the Subject

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Properties, objective, uniform, non-discriminatory standards and procedures for

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informing persons about and showing available dwelling units to prospective tenants, to

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include a standard rental application, waiting list, and lease. Such standards and

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procedures shall be submitted to the United States for approval in advance of their

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implementation. The standards and procedures shall be posted and prominently

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displayed in any office where the Independent Manager(s) conducts rental activity and/or

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has personal contact with applicants, and a copy of these standards and procedures shall

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be made available upon request to any applicant for the rental of one of the Subject

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Properties. These standards and procedures may be modified only if written notice is

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given to the United States thirty (30) days before the proposed modifications are to take

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effect and the United States makes no objection thereto prior to the proposed effective

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date.

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22.

The nondiscriminatory standards and procedures discussed in paragraph 21, above, shall

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include the use of the following documents, which the Independent Manager(s) shall

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update as new information becomes available, and retain for the duration of the Consent

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Decree:

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a. Rental Applications: Independent Manager(s) and/or their agents/employees shall
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provide and process rental applications on a non-discriminatory basis and shall

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maintain all rental applications, whether deemed complete or incomplete, as well as

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any correspondence about the availability of dwelling units. The standard rental

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Consent Decree

application must include the following phrase in boldface type, using letters of equal

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or greater size to those of the text in the body of the document:

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We are an equal housing opportunity provider. We
do not discriminate on the basis of race, color, sex,
national origin, religion, disability or familial status
(having children under age 18).

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b. Waiting Lists: Independent Manager(s) and/or their agents/employees shall maintain

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waiting lists in a non-discriminatory manner and develop uniform standards for

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selecting individuals from the list.

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c. Leases: Independent Manager(s) and/or their agents/employees shall enter into

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written leases with tenants in a non-discriminatory manner and develop uniform

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standards for executing and maintaining the leases.

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VI. COMPLIANCE TESTING

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23.

The United States may take steps to monitor the Defendant’s compliance with this

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Consent Decree including, but not limited to, conducting fair housing tests at any

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location(s) in which the Defendant’s employees or agents conduct rental activities.

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VII. ACQUISITION OR TRANSFER OF INTEREST IN SUBJECT PROPERTIES

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24.

If, at any time while this Consent Decree remains in effect, the Defendant decides to sell

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or otherwise transfer the entirety of his interest in any of the Subject Properties to an

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unrelated party in an arms-length transaction, 2 the Defendant shall take the following

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steps:

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For purposes of this Consent Decree, “arms-length transaction” is defined as a transaction
that has been arrived at in the marketplace between independent, non-affiliated persons,
unrelated by blood or marriage, with opposing economic interests regarding that transaction.
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Consent Decree

a. At least thirty (30) days prior to completion of the sale or transfer, provide each

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prospective purchaser or other transferee a copy of this Consent Decree along with

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written notice that the property remains subject to section II of the Decree;

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b. At least thirty (30) days prior to completion of the sale or transfer, provide the United

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States written notice of the Defendant’s intent to sell or otherwise transfer interest in

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the property, along with a copy of the notice sent to each prospective purchaser or

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transferee, containing the latter’s name, address, and telephone number;

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c. Within thirty (30) days following completion of the sale or other transfer, the

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Defendant shall provide the United States a copy of the documents memorializing the

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transfer in interest of the property.

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25.

If the Defendant complies with paragraph 24(a)–(c), and transfers all ownership,

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management, or other financial interest in each of the Subject Properties to an arms-

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length purchaser or other transferee, and if the Defendant has no ownership,

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management, or other financial interest in any other residential rental property, then the

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Defendant shall thereafter be relieved of obligations under sections III through V of this

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Consent Decree with regard to the Subject Properties. Transfer of interest in the Subject

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Properties does not relieve the Defendant of obligations under sections II, VIII, IX, X,

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and XI of this Consent Decree.

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26.

If the proposed transfer of interest is not an arms-length transaction, the Defendant must

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comply with the requirements of paragraph 24(a)–(c). In addition, the Defendant shall

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remain jointly and severally liable, along with the purchaser or other transferee, for any

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violations of sections II–V and XII–XIV of this Consent Decree for its duration. The

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Consent Decree

Defendant shall remain liable for his obligations under sections II, VIII, IX, X, and XI of

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this Consent Decree.

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27.

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If at any time while this Consent Decree remains in effect, the Defendant intends to
acquire an ownership, management, or other financial interest in any other residential

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rental property, either in whole or in part, the Defendant shall notify the United States in

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writing at least thirty (30) days before completion of the transaction, providing the name

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and address of the property and the identity of the manager(s) of the property. Upon

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acquisition of any such property, that property shall be deemed one of the Subject

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Properties under the terms of this Consent Decree for its duration. In addition, within

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thirty (30) days following completion of the purchase, the Defendant shall provide the

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United States: (a) a statement specifying the nature of the Defendant’s interest in the

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property and a copy of the documents memorializing the acquisition of that interest; (b)

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the number of individual dwelling units at the property; (c) the names of any existing

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tenants; and (d) the sex of each such tenant, based on the good faith observation of the

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Independent Manager(s).

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VIII. COMPENSATION OF AGGRIEVED PERSONS AND CIVIL PENALTY

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28.

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The Defendant agrees that entry of this Consent Decree constitutes the entry of a civil
judgment against him in the total amount of TWO MILLION, ONE HUNDRED

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THIRTY THOUSAND DOLLARS ($2,130,000) (“Judgment”).
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29.

Of the two million, one hundred thirty thousand dollar ($2,130,000) Judgment, two

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million, seventy five thousand dollars ($2,075,000) is monetary damages to compensate

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persons aggrieved by the Defendant’s conduct and to pay the fees and costs incurred by

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counsel for the Private Plaintiffs.

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Consent Decree

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30.

The two million, seventy-five thousand dollars ($2,075,000) in damages referenced in

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paragraph 29 is a debt for willful and malicious injury by the Defendant of the aggrieved

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persons. The Defendant agrees that the two million, seventy-five thousand dollars

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($2,075,000) in damages referenced in paragraph 29 is not dischargeable in bankruptcy.

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Defendant shall not seek to discharge any part of this debt in bankruptcy.

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31.

Of the two million, one hundred thirty thousand dollar ($2,130,000) Judgment, fifty-five

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thousand dollars ($55,000) is a civil penalty payable to the United States pursuant to 42

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U.S.C. § 3614(d)(1)(C) to vindicate the public interest.

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32.

The payment required under paragraph 31 above constitutes a debt for a fine, penalty, or

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forfeiture payable to and for the benefit of the United States within the meaning of 11

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U.S.C. § 523(a)(7) and is not compensation for actual pecuniary loss. The Defendant

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agrees that the fifty-five thousand dollars ($55,000) in civil penalty referenced in

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paragraph 31 is not dischargeable in bankruptcy. Defendant shall not seek to discharge

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any part of this debt in bankruptcy.

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33.

Of the two million, one hundred thirty thousand dollar ($2,130,000) Judgment:

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a. Eight hundred sixty-five thousand dollars ($865,000) shall be satisfied by the

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conveyance of thirty (30) residential properties to the plaintiffs, as outlined in

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paragraph 36 below. The properties to be conveyed are identified in Appendix A to

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this Consent Decree.
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b. One million, two hundred sixty-five thousand dollars ($1,265,000) is to be suspended,
subject to the provisions in paragraphs 43–47 below.
IX. TRANSFER OF PROPERTIES TO TRUST

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Consent Decree

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34.

In order to effectuate the Judgment, the United States will establish a trust or similar legal

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entity (“Trust”) for the purpose of compensating the Private Plaintiffs and aggrieved

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individuals identified by the United States, paying the civil penalty to the United States,

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and paying costs and attorneys fees to counsel for the Private Plaintiffs.

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35.

The Trust will be administered by a trustee or trustees (“Trustee”) to be selected by the

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United States. The Trustee will be an individual or entity knowledgeable in California’s

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trust laws and experienced in trust administration, including the management and

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liquidation of residential real property. The Trustee will meet all applicable legal

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requirements for serving as a trustee in connection with the settlement of these cases. In

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carrying out its responsibilities, including those relating to the distribution of Trust assets,

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the Trustee will take its direction from the United States. The terms of the Trust,

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including but not limited to its duration, the Trustee’s powers, compensation for the

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Trustee and removal of the Trustee, will be set forth in a trust instrument to be prepared

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by or on behalf of the United States, in compliance with the California Probate Code.

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36.

The Defendant shall transfer his entire interest in each of the dwellings listed in Appendix

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A to the Trust or Trustee. That transfer shall proceed as follows:

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a. The United States or its agent shall deliver quitclaim or grant deeds (“Deeds”) for

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execution to the Defendant. The Deeds will effect a transfer of the Defendant’s entire

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interest in the properties listed at Appendix A (“Transferred Properties”).
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b. Within five (5) days of delivery to the Defendant of each of the Deeds, the Defendant

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shall execute each of those Deeds before a notary public and cause the fully executed

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deeds to be delivered to the United States or its designated agent.

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Consent Decree

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c. At the time of transfer, the Transferred Properties will be encumbered only by the

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mortgages and taxes Defendant identified in the Financial Disclosure Statement dated

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August 28, 2012, discussed in paragraph 43, upon which the United States and the

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Private Plaintiffs have relied. The Defendant represents that any and all liens,

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mortgages, securities, or other encumbrances secured by any of the Transferred

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Properties have been identified in the Financial Disclosure Statement and that copies

8

of any such liens, mortgages, securities, or other encumbrances on the Transferred

9

Properties have been produced with the Financial Disclosure Statement.

10

d. Concurrent with the delivery of the executed Deeds, the Defendant shall provide

11
12

copies of any required notices to any person or entity regarding the transfer of the

13

Transferred Properties, including but not limited to any tax authorities, local

14

government entities, or lien or mortgage holders. The Defendant further agrees to

15

cooperate in the execution of any documents required to effect the assumption of any

16

mortgage obligations secured by any of the Transferred Properties by the Trust or

17
18
19

Trustee.
e. The Defendant further agrees to undertake, participate, and cooperate in performing

20

or completing the acts described in this paragraph and any other act required to effect

21

a complete transfer of the Defendant’s entire interest in each of the Transferred

22
Properties to the Trust or Trustee.
23
24

f. In the event that the Defendant fails or refuses to cooperate in any reasonable action

25

to accomplish the transfer of the Transferred Properties, he hereby stipulates that his

26

attorney may serve as his agent for all purposes associated with the transfer

27
28
17

Consent Decree

provisions of this paragraph. The Defendant shall execute a Limited Power of

1

Attorney, attached as Appendix D, in order to effect the terms of this provision.

2
3

37.

4

The Defendant agrees not to sell, transfer, encumber, reduce the value of, or otherwise
dissipate his assets, including the Transferred Properties identified in Appendix A,

5
between the date he signs this Consent Decree and the conveyance of his properties as

6

outlined above.

7
8

38.

9

The Trust or Trustee will receive, maintain, manage, sell, and/or otherwise appropriately
dispose of the residential properties being conveyed by the Defendant pursuant to

10

paragraph 36, and such other properties or assets as may be identified and conveyed to

11
the Trust or Trustee, pursuant to paragraph 45.

12
13

39.

The Defendant, to the extent necessary as determined by the United States, will provide

14

such full and timely cooperation to the United States and the Trustee, including but not

15

limited to information, documents, assistance, signatures, transfer of title, and power of

16

appointment, as is required to complete the establishment and operation of the Trust.

17
18

40.

The Trustee will be compensated and reimbursed out of the Trust assets for reasonable

19

administration expenses associated with administering the Trust, managing its assets, and

20

hiring necessary third parties to assist in administering and managing the Trust and its

21

assets. The terms of Trustee compensation and reimbursement will be set forth in the

22
trust instrument.
23
24

41.

Trust assets shall be distributed among the Private Plaintiffs, the aggrieved persons

25

identified by the United States in Appendix E, the law firm of Brancart & Brancart (for

26

payment of Private Plaintiffs’ attorneys’ fees, costs, and expenses), and the United States

27

(for payment of the civil penalty identified in paragraph 31). The Trust instrument will

28
18

Consent Decree

set forth the apportionment of the assets as between (1) the Private Plaintiffs, for

1
2

purposes of compensating the Private Plaintiffs and paying costs and attorneys’ fees

3

incurred by counsel for the Private Plaintiffs, and (2) the United States, for purposes of

4

compensating aggrieved persons identified by the United States and paying the civil

5
penalty referenced in paragraph 31. All distributions to the Private Plaintiffs will be

6
7

made to the attorney-client trust account of Brancart & Brancart. Upon distribution, the

8

United States will specify the amounts distributed through a separate notice

9

(“Disbursement Notice”) publicly filed with the Court. The Disbursement Notice will set

10

forth the amounts to be received by each individual or entity identified above. The

11
Defendant shall not have any right to object to the terms of the Trust instrument or to the

12

disbursements or the disbursement amounts identified in the Disbursement Notice.

13
14

42.

15

No aggrieved person shall receive a disbursement of trust assets until she has executed
and delivered to counsel for the United States the release at Appendix F. The Private

16

Plaintiffs and the Defendant will execute mutual releases in the form of Appendix G.

17
X. SUSPENDED JUDGMENT

18
19

43.

The Defendant has provided a financial disclosure statement and authorizations to release

20

information to the United States and the Private Plaintiffs in the forms of Appendix H

21

and has provided the documents and attachments required by that form (“Financial

22
Disclosure Statement”). The United States and the Private Plaintiffs have relied on the
23
24

accuracy and completeness of the Financial Disclosure Statement in entering into this

25

Consent Decree, particularly with respect to paragraphs 28–29, 34, and 43–47. The

26

Defendant warrants that the Financial Disclosure Statement is thorough, accurate, and

27

complete. The Defendant further warrants that he does not own or have an interest in any

28
19

Consent Decree

asset(s) that has not been disclosed in the Financial Disclosure Statement, and that he has

1
2

made no misrepresentations on, or in connection with, the Financial Disclosure

3

Statement.

4

44.

In light of the Defendant’s representations in connection with the Financial Disclosure

5
Statement, one million, two hundred sixty-five thousand dollars ($1,265,000) of the

6
7

Judgment imposed by paragraph 28 will be suspended (“Suspended Judgment”). Neither

8

the United States nor the Private Plaintiffs will seek to enforce the Suspended Judgment

9

against assets identified in the Financial Disclosure Statement dated August 28, 2012.

10

Any assets owned by the Defendant, whether in whole or in part, which are not disclosed

11
or the value or status of which is misrepresented on the Financial Disclosure Statement

12
13

are not covered by this paragraph and will be available to satisfy the Suspended

14

Judgment.

15
16

45.

Any plaintiff may act to collect all or part of the amount of the Suspended Judgment,
including by conducting discovery designed to identify and locate assets not identified on

17
18

the Financial Disclosure Statement. The Defendant shall not oppose any such efforts.

19

Upon discovery of an asset owned by the Defendant or in which the Defendant has an

20

interest that was not disclosed in the Financial Disclosure Statement, or a

21

misrepresentation by the Defendant on the Financial Disclosure Statement, any plaintiff

22
may apply to the Court for an order to enforce the Judgment in paragraph 28, including
23
24

an order transferring possession of the asset(s) to the Trust or Trustee for the purpose of

25

satisfying all or part of the Suspended Judgment. The Defendant agrees not to contest

26

plaintiffs’ right to such asset(s).

27
28
20

Consent Decree

1

46.

Any asset(s) conveyed to the Trust or Trustee pursuant to paragraph 45 will be disbursed

2

according to the trust instrument and Disbursement Notice(s), as set forth in paragraph 41

3

of this Consent Decree.

4

47.

In no event will the value of assets conveyed to the Trust or Trustee pursuant to

5
paragraph 45, not including any interest earned while held by the Trust or Trustee, exceed

6

the amount of the Suspended Judgment.

7

XI. VACATION OF EVICTION JUDGMENTS

8
9

48.

10

Within seven (7) days of a request by the United States, the Defendant will execute and
cooperate fully in the completion and filing of any and all necessary documents to vacate

11
eviction and related judgments and/or strike unlawful detainer complaints filed or entered

12
13

against the Private Plaintiffs and all aggrieved persons identified by the United States,

14

including but not limited to the case numbers identified in Appendix I. The Defendant

15

shall execute and cooperate fully in the filing of any and all motions, affidavits, notices of

16

non-opposition, notices of joinder, or other filings that may be required. The cooperation

17
required by this paragraph includes any necessary court appearance(s) in Kern County

18
19

Superior Court. The cooperation required by this paragraph also includes the execution

20

of any and all documents required to remove information regarding an eviction judgment

21

obtained by the Defendant from any credit reporting agency.

22
XII. SCOPE AND DURATION OF CONSENT DECREE

23
24

49.

The provisions of this Consent Decree shall apply to all of the Defendant’s agents,

25

employees, heirs, successors and assigns, and all persons acting in active concert or

26

participation with him.

27
28
21

Consent Decree

1

50.

This Consent Decree shall remain in effect for five (5) years after the date of its entry.

2

By consenting to entry of this Consent Decree, the United States and the Defendant

3

further agree that in the event the Defendant engages in any future violation(s) of the Fair

4

Housing Act, such violation(s) shall constitute a “subsequent violation” pursuant to 42

5
U.S.C. § 3614(d)(1)(C)(ii).

6
7

51.

The Court shall retain jurisdiction for the duration of this Consent Decree to enforce its

8

terms, after which time the case shall be dismissed with prejudice. The United States and

9

the Private Plaintiffs may move the Court to extend the duration of the Consent Decree in

10

the interests of justice.

11
XIII. TIME FOR PERFORMANCE

12
13

52.

Any time limits for performance imposed by this Consent Decree may be extended by

14

mutual written agreement of the parties. The other provisions of this Consent Decree

15

may be modified by written agreement of the parties or by motion to the Court. If the

16

modification is by written agreement of the parties, then such modification will be

17
effective upon filing of the written agreement with the Court and shall remain in effect

18
19

for the duration of the Consent Decree or until such time as the Court indicates through

20

written order that it has not approved the modification.

21

XIV. MISCELLANEOUS

22
53.

The parties shall act in good faith to comply with all requirements imposed by this

23
24

Consent Decree. The parties shall endeavor in good faith to resolve informally any

25

differences regarding interpretation of and compliance with this Consent Decree prior to

26

bringing such matters to the Court for resolution. However, in the event the United

27

States or the Private Plaintiffs contend that there has been a failure by the Defendant,

28
22

Consent Decree

whether willful or otherwise, to perform in a timely manner any act required by this

1
2

Consent Decree or otherwise to act in conformance with any provision thereof, the

3

United States and/or the Private Plaintiffs may move this Court to impose any remedy

4

authorized by law or equity, including, but not limited to, an order requiring performance

5
of such act or deeming such act to have been performed, and an award of any damages,

6
7

costs, and reasonable attorneys’ fees which may have been occasioned by the violation or

8

failure to perform.

9

54.

10

During the period in which this Consent Decree is in effect, the Defendant shall preserve
all records that are the source of, contain, or relate to any of the information pertinent to

11
his obligations under this Consent Decree, including, but not limited to availability lists,

12
13

waiting lists, rental applications, leases, rental roll ledgers, and occupancy lists. Upon

14

reasonable notice to counsel for the Defendant, representatives of the United States shall

15

be permitted to inspect and copy all such records at any and all reasonable times or, upon

16

request by the United States, the Defendant shall provide copies of such documents.

17
18

55.

The parties agree that, as of the date of the entry of this Consent Decree, litigation is not

19

“reasonably foreseeable” concerning the matters described above. To the extent that

20

either party previously implemented a litigation hold to preserve documents,

21

electronically stored information (ESI), or things related to the matters described above,

22
the party is no longer required to maintain such litigation hold. Nothing in this paragraph
23
relieves either party of any other obligations imposed by this Consent Decree.

24
25
26

56.

The United States and the Defendant will bear their own costs and attorneys’ fees
associated with this litigation.

27
28
23

Consent Decree

1

September
13th
IT IS SO ORDERED this ________ day of ___________________, 2012.

2
3
4

/s/ Jennifer L. Thurston
__________________________________
HON. JENNIFER L. THURSTON
United States Magistrate Judge

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
24

Consent Decree

1

Appendix A

2

1.

1221 Antonia Way, Bakersfield

3

2.

2413 Bernice Court, Bakersfield

4

3.

1920 Bradley Avenue, Bakersfield

5

4.

5117 Brockton Court, Bakersfield

5.

5013 Centaur Street, Bakersfield

6

6.

5800 Don Street, Bakersfield

7

7.

5804 Don Street, Bakersfield

8

8.

1808 Doolittle Avenue, Bakersfield

9

9.

120 Dunlap Street, Bakersfield

10

10.

5521 Dustin Street, Bakersfield

11.

2908 Estero Street, Bakersfield

12.

3817 Evelyn Drive, Bakersfield

12

13.

3909 Evelyn Drive, Bakersfield

13

14.

2726 Gary Place, Bakersfield

14

15.

4204 Gordon Street, Bakersfield

15

16.

4608 Hahn Avenue, Bakersfield

17.

701, 703A, 703B Hill Street, Bakersfield

11

16

18.

106 Jefferson Street, Bakersfield

17

19.

308 and 310 Jones Street, Bakersfield

18

20.

2726 Karen Place, Bakersfield

19

21.

1800 Mallard Court, Bakersfield

20

22.

2309 Manor Street, Bakersfield

23.

2608 Miria Drive, Bakersfield

21

24.

2612 Miria Drive, Bakersfield

22

25.

2617 Miria Drive, Bakersfield

23

26.

2711 Poppy Street, Bakersfield

24

27.

5833 Sparks Street, Bakersfield

25

28.

1415 Sylvia Drive, Bakersfield

29.

1313 Terrace Way, Bakersfield

30.

417 Troy Street, Bakersfield

26
27
28

Appendix B

1
2

NONDISCRIMINATION POLICY

3
4
5
6
7
8
9

It is the policy of Rawland Leon Sorensen to comply with Title VIII of the Civil Rights
Act of 1968, as amended, commonly known as the Fair Housing Act, by ensuring that his rental
properties are available to all persons without regard to race, color, religion, national origin,
disability, familial status (having children under age 18), or sex. This policy means that, among
other things, Rawland Leon Sorensen and any and all agents and employees with the
responsibility for renting, managing, or administering any dwelling units must not engage in
discrimination on the basis of sex, including any illegal sexual harassment of tenants or potential
tenants. Rawland Leon Sorensen and any such agents and employees may not:
A.

10
11

B.

12
13

C.

14
15

D.

16
17
18

E.

Refuse to rent, refuse to negotiate for the rental of, or otherwise make unavailable
or deny, a dwelling to any person because of race, color, religion, national origin,
disability, familial status, or sex;
Discriminate against any person in the terms, conditions or privileges of rental of
a dwelling, or in the provision of services or facilities in connection therewith,
because of race, color, religion, national origin, disability, familial status, or sex;
Make, print, or publish, or cause to be made, printed, or published any notice,
statement, or advertisement, with respect to the rental of a dwelling that indicates
any preference, limitation, or discrimination based on race, color, religion,
national origin, disability, familial status, or sex;
Represent to persons because of race, color, religion, national origin, disability,
familial status, or sex that any dwelling is not available for inspection or rental
when such dwelling is in fact so available; or
Coerce, intimidate, threaten, or interfere with persons in the exercise or enjoyment
of, or on account of their having exercised or enjoyed, their rights under the Fair
Housing Act.

19
20
21
22
23
24
25
26
27
28

Rawland Leon Sorensen or any agent or employee who fails to comply with this
Nondiscrimination Policy will be subject to appropriate disciplinary action. Any action taken
that results in unequal service to, treatment of, or behavior toward tenants or actual or potential
applicants on the basis of race, color, religion, national origin, disability, familial status, or sex
may constitute a violation of state and federal fair housing laws. Any tenant or applicant who
believes that any of the above policies have been violated by any owner, agent, or employee
should file a written complaint with the Independent Manager(s) by contacting ______________.
The Independent Manager(s) shall immediately investigate the complaint and take the necessary
remedial actions. An individual who believes that he or she is the victim of discrimination may
also contact the U.S. Department of Housing and Urban Development at 1-800-440-8091 x 2493,
or the U.S. Department of Justice at 1-800-896-7743 x 992 or 202-514-4713.

1

Appendix C

2

EMPLOYEE ACKNOWLEDGMENT

3
4

I acknowledge that on ___________________, 201__, I was provided copies of the

5

Consent Decree entered by the Court in Hawecker et al. v. Rawland Leon Sorensen, Nos. 1:10-

6

cv-00085; 1:11-cv-00511 (E.D. Cal.), and the Nondiscrimination Policy of Rawland Leon

7

Sorensen. I have read and understand these documents and have had my questions about these

8
9
10
11
12

documents answered. I understand my legal responsibilities and shall comply with those
responsibilities.
_________________________________
Signature

13
14
15

_________________________________
Print Name

16
17

_________________________________
Job Title

18
19
20

_________________________________
Home Address

21
22

_________________________________
Home Address Continued

23
24
25

_________________________________
Home Telephone Number

26
27
28

_________________________________
Date

Appendix D

1

Appendix E

2

Marquesha Benford

3

Diana Bermudez

4

Melissa Brown

5

Ruby Childs

6

Capricia Cobb

7

Khalifia Cox

8

Sheila Davis

9

Patrice Denweed

10

Andrea Garcia

11

Shannon Guevara

12

La Quice Holmes

13

Melissa Johnston

14

Dominique Jones

15

Tina Jones

16

Carlishia Laney

17

Joann Martinez

18

Lynnette Mays

19

Jeri Miller

20

Shelle Miller

21

Tashawn Sharp

22

Karen Sorensen

23

Kenya Webber

24

Denise Williamson

25
26
27
28

1
2

Appendix F
FULL AND FINAL RELEASE OF CLAIMS

3

In consideration for the parties’ agreement to the terms of the Consent Decree they entered into

4

in the case of Hawecker et al. v. Rawland Leon Sorensen, Nos. 1:10-cv-00085; 1:11-cv-00511

5

(E.D. Cal.), as approved by the United States District Court for the Eastern District of California,

6

and in consideration for the payment of $_______________, I, __________________________,

7

do hereby fully release and forever discharge Rawland Leon Sorensen, along with his insurers,

8

attorneys, agents, employees, former employees, heirs, executors, and administrators and any

9

persons acting under his respective direction or control from any and all fair housing claims set

10

forth, or which could have been set forth, in the Complaint in this lawsuit that I may have had

11

against any of them for any of Rawland Leon Sorensen’s actions or statements related to those

12

claims through the date of the entry of the Consent Decree.

13
14

Executed this _____ day of __________________, 2012.

15
16
17

_________________________________
Signature

18
19

_________________________________
Print Name

20
21
22

_________________________________
Home Address

23
24
25
26
27
28

_________________________________
Home Address Continued

Appendix G

MUTUAL RELEASE
This Mutual Release, dated August
, 2012, is executed by and between Carrie
Hawecker and Michelle Broussard,(collectively, the " private plaintiffs"), on the one hand,
and Rawland Leon Sorensen (the "defendant"), on the other hand.
FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, the
private plaintiffs and defendant, for themselves, their successors, heirs and assigns, fully
and forever release, acquit, and forever discharge each other, and each and every one of
their affiliates, successors, assigns, heirs, administrators, controlling and/or otherwise
related entities, partners, employers, employees, attorneys, servants, agents, officers,
directors, and all other representatives, of and from all claims, actions, causes of action,
demands, rights, damages, costs, expenses, and compensation whatsoever, whether
known or unknown, foreseen or unforeseen, which the undersigned have now or which
may hereafter accrue, relating to, or in any way connected with, the events and
occurrences as set forth and described in and which are the subject of the complaint
pending in the United States District Court for the Eastern District of California, Carrie
Hawecker, et al. v. Rawland Leon Sorensen Case No. 10-CV-85 JLT (the "Action"), except
for and subject to the terms and conditions set forth in the consent decree entered by the
District Court pursuant to the settlement of this action.
This is intended as a full and complete release and discharge of any and all claims
that the undersigned may or might have or had by reason of the incidents or activities as
alleged in the Complaint except for and subject to the terms and conditions set forth in the
consent decree entered by the District Court pursuant to the settlement of the Action.
All rights under Section 1542 of the Civil Code of the State of California are hereby
expressly waived. The undersigned understands that said Section 1542 of the Civil Code
provides as follows:
A general release does not extend to claims which the creditor does not
know or suspect to exist in his favor at the time of executing the release,
which, if known by him, must have materially affected his settlement with the
debtor.
The undersigned hereby declare and represent that the undersigned are executing
this Mutual Release after having received full legal advice as to their rights from their legal
counsel.
Each signatory is legally competent and authorized to execute this agreement on
behalf of the party whose name is subscribed at the signatories' line.
This Release may be executed in counterparts.
///
///
///

Page 1 of 2

The undersigned hereby certify that the undersigned have read all of this release
and Civil Code section and fully understand all of same.

Carrie Hawecker

Date

Michelle Broussard

Date

Rawland Leon Sorensen

Date

APPROVED AS TO FORM AND CONTENT BY:

Christopher Brancart
Attorney for Plaintiffs

Date

M. Greg Mullanax
Attorney for Defendant

Date

Page 2 of 2

1

Appendix H

2

U.S. DEPARTMENT OF JUSTICE

3

United States Attorney
Eastern District of California

4
5

AUTHORIZATION TO RELEASE INFORMATION

6
7

To whom it may concern:

8

In connection with a financial investigation being conducted by the United States Attorney, I,

9
Print Full Name

10
11
12
13

hereby authorize any authorized representative of the United States Attorney bearing this release, or a copy
thereof, within one year of its date, to obtain any information in your files pertaining to employment, military,
credit, educational, or business records, including, but not limited to, attendance, licensing, disciplinary, credit,
medical, financial, city, state, and federal tax records, returns and supporting documentation, bank records, and/or
records maintained by any city, state, and/or federal agency. I hereby direct you to release such information upon
request of the bearer.

14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

This release is executed with full knowledge and understanding that the information will be used in connection with
the consideration of my liability on a debt claimed by the United States and my financial ability to pay said debt.
Information will be disseminated only to those individuals and agencies directly involved in this determination or to
fulfill other obligations imposed by law, regulation, presidential directive or executive order.
I hereby release you, as the custodian of such records, and the school, college, university, or other educational
institution, hospital or other repository of medical records, credit bureau, lending institution, financial institution,
consumer reporting agency, retail business establishment, insurance company, or public agency, including officers,
directors, employees, or related personnel, both individually or collectively, from any and all liability for damages
of whatever kind, which may at any time result to me, my heirs, family, or associates, because of compliance with
this authorization and request to release information, or any attempt to comply with it. If there are any questions as
to the validity of this release, you may contact me as indicated below.
_______________________
Date

_________________________________________________
Signature

_______________________
Phone Number

_________________________________________________
Print Full Name

_______________________
Social Security Number

_________________________
Date of Birth

_____________________________________________________________________________________
Resident Street Address
City
State
Zip Code

1
2
3

GENERAL AUTHORIZATION FOR RELEASE OF RECORDS
TO WHOM IT MAY CONCERN:
The undersigned hereby authorizes ________________ (Company, Official or Agency) or its

4

representative, to procure and disclose a copy of my records to CHRISTOPHER BRANCART,

5

BRANCART & BRANCART, P.O. BOX 686, PESCADERO, CA 94060; TEL: [phone];FAX: (650)

6

879-1103;EMAIL: [e-mail], including 1) government benefit, such as housing, social

7

security, and income maintenance records, 2) criminal justice records, such as police, arrest, police

8

report, court, prison, probation, and parole records, 3) housing records, such as tenant, loan, purchase,

9

sale, rental records, credit reports, and financial information, 4) financial records, such as bank, credit,

10

and loan information, and/or 5) communication records, such as telephone, cell, website, email and other

11

electronically stored information. This authorization does not cover medical records. This

12

authorization shall be valid for one year after its date of execution. A photocopy of this Authorization shall

13

be considered as valid as the original.

14

__________________________

15

Today’s Date

16
17
18

_______________________________
Signature

_______________________
Name/Print

19
20
21

_____________________________________________________________________
Address

22
23
24

______________________________
Social Security Number

__________________________
Date of Birth

25
26
27
28

_______________________________
Telephone Number

___________________________
Message Number

U.S. DEPARTMENT OF JUSTICE
United States Attorney
Eastern District of California

INDIVIDUAL FINANCIAL DISCLOSURE STATEMENT
Complete this questionnaire for you and your spouse.
If more space is needed use page provided at end of document.

Section 1: Personal Information
1.

Full Name: ___________________________________ Maiden name: ________________________

2.

Other names ever used: _______________________________________________________________

3.

Birth date: _____________________

Social Security Number (SSN): ________________________

Place of birth (city, state & country): ____________________________________________________
4.

Driver’s license #: ____________________

State: _____________

5.

Marital Status: G Single

G Separated

6.

Home address: ______________________________________________________________________

G Married

City: __________________________________

Exp. date: _______________

G Divorced

State: ________________

G Widowed

Zip: ______________

Home phone: __________________________ Work phone: ________________________________
Cell phone: _________________________ Email address: __________________________________
7.

Previous addresses (past 10 years): ______________________________________________________
City: __________________________________

State: ________________

Zip: ______________

Dates at this address: ______________________________________
Prior to above address: _______________________________________________________________
City: __________________________________

State: ________________

Zip: ______________

Dates at this address: ______________________________________
8.

Education. List all schools attended after high school (including trade schools and any other formal or
informal training), years attended and degree obtained (if any):
___________________________________________________________________________________
___________________________________________________________________________________

9.

Professional licenses:
Type: ____________________________ Number: _________________ Exp. date: ____________
Type: ____________________________ Number: _________________ Exp. date: ____________

Individual Financial Disclosure Statement

Page 1 of 16

Section 2: Family Information
10. Spouse/Companion’s full name1: __________________________ Maiden name: ________________
11. Other names ever used: _______________________________________________________________
12. Date of marriage: __________________ Place of marriage: _________________________________
13. Spouse’s birth date: _____________________

Spouse’s SSN: ______________________________

14. Spouse’s driver’s license #: __________________ State: ____________ Exp. date: ____________
15. Spouse’s parents’ full names: __________________________________________________________
16. List each family members full name and date of birth (include step parents, siblings and children):
Father:

_____________________________________________

DOB: ______________________

Mother: _____________________________________________

DOB: ______________________

Brothers: _____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

Daughters: ____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

_____________________________________________

DOB: ______________________

Sisters:

Sons:

17. Identify all persons living in your home and their relationship to you:
Name: _______________________________________ Relationship: ________________________
Name: _______________________________________ Relationship: ________________________
Name: _______________________________________ Relationship: ________________________
Name: _______________________________________ Relationship: ________________________
Name: _______________________________________ Relationship: ________________________

1

If you do not have a spouse but do have a companion or partner then answer all questions in this
document that say spouse as if it said companion or partner.
Individual Financial Disclosure Statement

Page 2 of 16

Section 3: Employment Information
18. Current employer/business information. Check appropriate box:
G Wage Earner
G Self-Employed

G Partner
G Corporate Owner

G Retired
G Unemployed

Occupation: ___________________________ Position/title: ________________________________
Name of business: ___________________________________________________________________
Primary business activity: _____________________________________________________________
Business address: ____________________________________________________________________
City: ___________________________________ State: ________________ Zip: ______________
Business website: ____________________________________________________________________
Person to Contact: ________________________________ Phone No.: ________________________
Annual pay (including overtime and bonuses): $ ______________ Years at this business: _________
If business owner or stock holder: How long have you owned this business: ___________________
Employer Identification No.: ______________________

Percentage of ownership: ___________

What is your investment worth in this business at current market value: $ _____________________
Current market value is the amount that you would expect to receive if you sold business today.
19. Other full and/or part-time employment within the last 5 years:
Business Name

Address

Owner?

Employment Dates

20. Spouse’s current employer/business information. Check appropriate box:
G Wage Earner
G Self-Employed

G Partner
G Corporate Owner

G Retired
G Unemployed

Occupation: ___________________________ Position/title: ________________________________
Name of business: ___________________________________________________________________
Primary business activity: _____________________________________________________________
Business address: ____________________________________________________________________
City: ___________________________________ State: ________________ Zip: ______________
Business website: ____________________________________________________________________
Person to Contact: ________________________________ Phone No.: ________________________
Annual pay (including overtime and bonuses): $ ______________ Years at this business: _________
Individual Financial Disclosure Statement

Page 3 of 16

If business owner or stock holder: How long have you owned this business: ____________________
Employer Identification No.: ______________________

Percentage of ownership: ____________

What is your investment worth in this business at current market value: $ ______________________
Current market value is the amount that you would expect to receive if you sold business today.
21. Spouse’s other full and/or part-time employment within the last 5 years:
Business Name

Address

Owner?

Employment Dates

Section 4: Taxes
22. Did you file a Federal Income Tax Return last year? G Yes G No

If yes: G Joint

G Individual

Form No.: ___________ Adjusted Gross Income reported: $ _________ Where filed: _____________
23. Do you expect to receive a tax refund from any federal, state, or local government? G Yes G No
If yes, provide details:
Government Entity

Type of Tax

Year(s)

Amount
$
$
$

24. Do you or your spouse owe any delinquent taxes? G Yes
Government Entity

Type of Tax

G No

If yes, provide details:
Year(s)

Amount of Debt
$
$
$

Individual Financial Disclosure Statement

Page 4 of 16

Section 5: Income
25. State monthly income for each category below for you and your spouse. If income varies, add your
income over the last 12 months and divide by 12. If you or your spouse own a business attach Profit &
Loss Statements, Balance Sheets, Statements of Cash Flows, and business income tax returns for the last
two years and part-year statements for the period between the end of the last fiscal year and today’s
date. If employed attach most recent pay stub(s). Also attach personal income tax returns for the last
two years and supporting documentation for all other types of income listed:
Your Monthly Income

Spouse’s Monthly Income

Total Salary / Wages

$

Total Salary / Wages

$

Take-home Salary / Wages

$

Take-home Salary / Wages

$

Commissions

$

Commissions

$

Bonus Income

$

Bonus Income

$

Total Business Income

$

Business Income

$

Take-home Business Income

$

Take-home Business Income

$

Profit Sharing

$

Profit Sharing

$

Rental Income

$

Rental Income

$

Interest / Dividends

$

Interest / Dividends

$

Unemployment

$

Unemployment

$

Disability

$

Disability

$

AFDC / Food Stamps

$

AFDC / Food Stamps

$

Pensions / Annuities

$

Pensions / Annuities

$

Social Security

$

Social Security

$

Child Support

$

Child Support

$

Alimony

$

Alimony

$

Gifts from Relatives

$

Gifts from Relatives

$

Other Gifts

$

Other Gifts

$

Other 2

$

Other 2

$

Totals

$

Totals

$

26. Date to begin receiving pension, profit sharing, IRA distribution, Social Security,
and/or life insurance, if in the future: ________________ Amount per month: $ _________________
Name of Company: _______________________ Point of Contact and Phone No.: ________________
27. Whole life / universal life insurance: do you anticipated receiving any distributions from a whole life or
universal life insurance policy in next 12 months? G Yes G No If yes, amount $ _______________
Name of insurance company: ____________________________

Policy No.: ____________________

2

Any other income including periodic income, such as rebates, lottery winnings, tax refunds,
royalties, user fees, etc. (please specify, use separate sheet if necessary).
Individual Financial Disclosure Statement

Page 5 of 16

Section 6: Expenses
28. State monthly household expenses. Average over 12 months if necessary. Do not include any
expenses paid by your business:

Monthly Expenses

Monthly Expenses

Rent / Mortgage (primary)

$

Food

$

Other Rent / Mortgage

$

Clothing & Misc.

$

Property Taxes

$

Entertainment

$

Home Maintenance

$

Healthcare / Medical

$

Electricity

$

Alimony

$

Natural Gas / Propane

$

Child Support

$

Telephone

$

Child / Dependent Care

$

Water

$

Educational

$

Sewer

$

Other Secured Debt

$

Trash

$

Credit Cards

$

Other Utilities

$

Auto Insurance

$

Cable TV

$

Life Insurance

$

Internet

$

Home / Rental Insurance

$

Cell Phone

$

Health Insurance

$

Car / Truck Payment(s)

$

Other Insurance (Umbrella)

$

Boat / RV / Plane Payment(s)

$

Accounting (Personal)

$

Vehicle License Fees

$

Legal (Personal)

$

Vehicle Maintenance

$

Charitable Contributions

$

Gasoline

$

Gifts

$

Other:

$

Other Personal Expenses 3

$

$

Sub-Total Column 2

$

Sub-Total Column 1

Total of columns 1 and 2: $ _____________

3

Please itemize on separate sheet if amount exceeds $50 per month.

Individual Financial Disclosure Statement

Page 6 of 16

Section 7: Assets
Identify all assets held by you and/or your spouse. Specify if asset is held (owned) separately by
husband (H), wife (W), jointly (J), Business (B) or in a trust account (T). Attach the last three account
statements for all checking, other, and investment accounts listed:
29. Checking account(s):
Owner

Name(s) on Account

Name of Institution and Address

Account #

Balance
$

$

$

30. Other accounts (savings, certificates of deposit, pension, IRA, KEOGH, 401(k), deferred compensation,
retirement, etc.):
Owner

Name(s) on Account

Name of Institution and Address

Account #

Balance
$

$

$

31. Investments (stocks, bonds, mutual funds, government securities, etc.). Also indicate if used as
collateral on a loan:
Owner

Name of Company

Account #

# of Shares

Purchase Date

Value
$

$

$

Individual Financial Disclosure Statement

Page 7 of 16

32. Other personal investments valued at current market value:
Owner

Description

Purchase Date

Value
$
$
$

33. Other business investments at current market value:
Owner

Description

Purchase Date

Value
$
$
$

34. Business assets (not listed elsewhere) at current market value:
Owner

Description

Purchase Date

Value
$
$
$

35. Self-employment business assets not listed elsewhere as personal property:
Owner

Description

Purchase Date

Value
$
$
$

36. Primary and secondary home financial information. Current value is the amount that you would expect
to receive if you sold your home today. Do not include the loan amount in the total liens. Attach copies
of recent loan and lien statements:
Primary home address: ______________________________________________________________
Original purchase price: $ _________________

Date of purchase: _________________________

Home current market value: $ ___________________ Loan(s) balance: $ ____________________
Total Liens: $ _______________ Lien Holders: _________________________________________

Individual Financial Disclosure Statement

Page 8 of 16

Secondary home address: ____________________________________________________________
Original purchase price: $ _________________

Date of purchase: _________________________

Home current market value: $ ___________________ Loan(s) balance: $ ____________________
Total Liens: $ _______________ Lien Holders: _________________________________________
37. Other investment property. Indicate type of property, e.g., apartment, condo, house, commercial, etc.
Current value is the amount that you would expect to receive if you sold this property today. Do not
include the loan balance as part of the total liens. Attach copies of recent loan and lien statements:
Address: ________________________________________________

Type: __________________

Original purchase price: $ __________________ Date of purchase: _________________________
Current market value: $ ___________________
Total Liens: $ _______________

Loan balance: $ __________________________

Lien Holders: _________________________________________

Address: ________________________________________________

Type: __________________

Original purchase price: $ __________________ Date of purchase: _________________________
Current market value: $ ___________________
Total Liens: $ _______________

Loan balance: $ __________________________

Lien Holders: _________________________________________

Address: ________________________________________________

Type: __________________

Original purchase price: $ __________________ Date of purchase: _________________________
Current market value: $ ___________________
Total Liens: $ _______________

Loan balance: $ __________________________

Lien Holders: _________________________________________

38. Cars, trucks and other vehicles:
Make & Model

Year

License No. & St.

Mileage

Value

Loan Bal.

$
$

$

$

$

$

Individual Financial Disclosure Statement

$

$

Page 9 of 16

39. Boat, RV, Aircraft, motorcycles, ATV’s and other recreational vehicles:
Make & Model

Year

License No. & St.

Hours/Miles

Value

Loan Bal.

$

$

$

$

$

$

$

$

$

$

40. Total current value of all personal assets:
Televisions, VCRs, CD or DVD players, computers, printers, stereos, video and digital
cameras, IPODS, cell phones, etc.:

$

Sporting goods, guns, fishing equipment, etc.:

$

Furniture, jewelry, antiques, art objects, stamp or coin collections, etc.:

$

Other (describe):

$

41. Money owed to you (list source and reason for debt):
Debtor Name & Phone Number

Reason for Debt

Amount
$
$
$
$

42. Money, or other assets, held by someone else on your behalf:
Person Holding Asset & Phone Number

Description of Asset

Value
$
$
$
$

Individual Financial Disclosure Statement

Page 10 of 16

43. Anticipated inheritance or benefit from a trust or claim:
Description: ____________________________________________________
Trustee name: _____________________________________

$ _________________

Phone No.: _______________________

44. Cash on hand (include any money that you have that is not in the bank):

$ _________________

45. Lawsuits in which you might receive something of value (include contact name and phone number):
Jurisdiction

Court & Case No.

Persons Involved and Status

Value
$

$

$

46. Other assets or anticipated assets (e.g., timeshare property, patents, copyrights, retainers, advance
payments, deposits, mineral interest and leases, etc.). Include contact name and phone number:
Description of Asset

Value
$
$
$
$
$

47. Life insurance. Do you have life insurance with a cash value? G Yes G No
If yes, provide details (term life insurance does not have a cash value):
Name and Address of
Insurance Company

Policy
Number

Type of
Policy

Face
Amount

Cash Surrender
Value

Amount
Borrowed

Amount You
can Borrow

$

$

$

$

$

$

$

$

Individual Financial Disclosure Statement

$

$

$

$

Page 11 of 16

Section 8: Liabilities
48. Mortgage/loan on home.

Primary loan current Balance:

$ ____________________

Secondary loan current Balance:

$ ____________________

Attach copy of recent mortgage statement and if refinanced or purchased within the last 3 years,
attached copy of the loan application.
49. Credit cards. Do you or your spouse have any credit cards? G Yes G No
and attach copies of the most recent statements:
Creditor Card Company

Account No.
Last 4 Digits

If yes, provide details
Monthly
Payments

Balance
$

$

$

$

$

$

$

$

$

$

$

$

$

$

50. Other loans. Do you or your spouse have any other loans payable? G Yes G No
If yes, provide details and attach copies of the most recent statements and loan applications submitted
within the last 3 years:
Creditor Name and Address

Type

Balance

Monthly Payments

$
$

$

$

$

$

Creditor Name

$

$

51. Are there any judgements against you? G Yes G No

$

$

If yes, provide details:
Date of Judgement

Amount of Debt
$
$
$

Individual Financial Disclosure Statement

Page 12 of 16

52. Are there any garnishments against your or your spouse’s wages? G Yes G No
If yes, provide details:
Creditor Name

Date of Judgement

Amount of Debt
$
$
$

53. Do you anticipated owing money from a pending judgment or claim? G Yes G No
If yes, provide details:
Description

Anticipated Debt
$
$
$

54. Do you or your spouse owe any large medical bills? G Yes G No

If yes, provide details:

Creditor Name

Amount of Debt
$
$
$

55. Do you or your spouse have any other liabilities? G Yes G No

If yes, provide details:

Description

Amount of Debt
$
$
$
$

Individual Financial Disclosure Statement

Page 13 of 16

Section 9: Other Information
56. Have you ever been divorced? G Yes G No
and provide details below:

If yes, attach a copy of divorce settlement or decree

Date of divorce: ______________ Location where filed: __________________________________
Name of former spouse: ________________________________

SSN: ______________________

57. List all transfers of property (including cash) by loan, gift, sale, barter, exchange, etc. that you and/or
your spouse have made within the last five years (items worth $2,500 or more):
Description
of Asset

Date of
Transfer

FMV When
Transferred

Amount
Received

$

$

$

$

$

$

58. Have you ever been involved in any bankruptcy proceedings? G Yes G No
Date

Jurisdiction

Case Number

59. Have you ever been a party to any civil suit? G Yes G No
Date

Jurisdiction

Transferee Name and
Relationship to Defendant

If yes, provide details:
Status

If yes, provide details:

Case Number

Persons Involved and Status

60. Are you affiliated with any partnerships or joint ventures? G Yes G No
Company Name & Address

If yes, provide details:

Percent Interest

Current Value

% $
% $

61. Are you an officer or director of any corporation? G Yes G No
Company Name & Address

If yes, provide details:
Begin and End Dates

Remuneration
$
$

Individual Financial Disclosure Statement

Page 14 of 16

62. Are you a participant in a profit sharing plan? G Yes G No
If yes, name of plan: __________________________________ Value in plan: $ _________________
63. Do you have a will and/or living trust? G Yes G No

If yes, attach copy.

64. Are you a trustee, executor, beneficiary, or administrator under any will or testament, insurance policy,
or trust agreement (including a family trust)? G Yes G No
If yes, provide details:
Description

65. • Do you have a safe deposit box? G Yes G No

Type

Relationship to You

If yes, provide information below for each box:

• Do you have assets or documents in someone else’s safe deposit box? G Yes G No
If yes, provide information below for each box:
• Are you a designated deputy and/or do you have access to someone else’s safe deposit box?
G Yes G No

If yes, provide information below for each box:

Name and Address of Location of Safe Deposit Box

Box No.

Contents

66. Provide details for all insurance policies held (except life insurance list earlier). Include details about
riders or supplemental insurance on personal assets (e.g., jewelry, antiques, etc.):
Type of Policy

Company Name

Policy Number

Coverage Limits

67. List any other assets not listed previously including any assets outside the United States:
Asset Description

Location

Value
$
$
$
$

Individual Financial Disclosure Statement

Page 15 of 16

Following is a summary of document copies you are required to attach:
1. Profit & Loss Statements, Balance Sheets and Statements of Cash Flows for the last two years for your
and/or your spouse’s business(es) and /or interest in partnerships. Also attach part-year Profit and Loss
Statement and Balance Sheet for period between the end of the last fiscal year and today’s date.
2. Your and your spouse’s most recent pay stub(s) or direct deposit statement(s), if employed.
3. Federal and State tax returns for the last two years (both business and individual). Attach copy of entire
tax return and all forms W-2 and 1099.
4. The most recent mortgage/loan statement(s) and lien documents.
5. The three most recent bank, financial institution, investment or other account statements for all of your
and/or your spouse’s business and personal accounts.
6. All loan and line-of-credit applications submitted by you or your spouse within the last 3 years.
7. Credit card statements.
8. Divorce settlement or decree(s), if any.
9. Will and/or living trust documents.
10. Signed “Authorization to Release Information” form (separate document).
PLEASE READ CAREFULLY BEFORE SIGNING
With knowledge of the penalties and liability for false statements provided by Title 18, United States
Code, Section 1001, with knowledge of the penalties and liability for false claims provided by Title 31,
United States Code, Section 3729 et seq., and with knowledge that this financial disclosure statement is
submitted by me to affect action by the United States Department of Justice, I hereby certify under
penalty of perjury that the above statements are true, accurate and correct and that it is a complete
statement of all my income and assets, real and personal, whether held in my name or by any other.
_______________________
Date

_________________________________________________
Signature
_________________________________________________
Print Full Name

_______________________
Date

_________________________________________________
Signature of Spouse/Companion
_________________________________________________
Print Full Name of Spouse/Companion

If you were assisted by someone in filling out this financial disclosure statement, please state that person’s
name and relationship to you, and have that person sign below:
_______________________
Date

_________________________________________________
Signature

_______________________
Relationship

_________________________________________________
Print Full Name

Note: If you have added additional sheets to this form or added information on the back of any page, you
must also sign these sheets.
Revised February 2010

Individual Financial Disclosure Statement

Page 16 of 16

Make copies of this sheet when additional space is needed. Indicate the question numbers on the left.
#

_______________________
Date

Details

_________________________________________________
Signature

Individual Financial Disclosure Statement

Add-on Page ____ of ____

1

Appendix I

2

S-1500-CL-208295

3

S-1500-CL-213081

4

S-1500-CL-214483

5

S-1500-CL-205558

6

S-1500-CL-193861

7

S-1500-CL-209051

8

S-1500-CL-195755

9

S-1500-CL-234976

10

S-1500-CL-217221

11

S-1500-CL-207839

12

S-1500-CL-228271

13

S-1500-CL-209405

14

S-1500-CL-185492

15

S-1500-CL-176511

16

S-1500-CL-198335

17

S-1500-CL-209405

18

S-1500-CL-192779

19

S-1500-CL-193727

20

S-1500-CL-262787

21

S-1500-CL-208628

22

S-1500-CL-223541

23

S-1500-CL-167834

24

S-1500-CL-238477

25

S-1500-CL-246067

26
27
28