UNITED STATES HOUSE OF REPRESENTATIVES
2007 FINANCIAL DISCLOSURE STATEMENT
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LEGISLATIVE RESOURCE CENTER
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Seer re cn A $200 penalty shall be assessed
2 against anyone who files more than
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Employee
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ity, complete and attach Schedule Vi
1, Dany india organization make a donation 'o chert in VL be you your spate, aceon ciao apy
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igo arplee and attach Schedul Ifyoo Semple and atseh Schedule Vi
TL Od yu, yout spose, ra doperdet cid elo undamod? Mil Dd you het any potable posions on oboe the
‘ncamo 6! more than $200 in the reporting perod or Mod any Yes No] —] | date ot hig in tne curert calendar year?
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en, complete and attach Sched i
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ee eet ES
Seba tea Ne rearants eat ifjeocompicte and attach Schedule IX
iyen complete and atadh Schudule i
loehiy fre her St600| debe tkemeorma sear vesIT | wo! Each question in this part must be answered and the
ites Complate and steer Schedule ‘es [\ [71 appropriate schedule attached for each "Yes" response.
EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST INFORMATION — ANSWER EACH OF THESE QUESTIONS
‘TAUSTS—Delails regarding "Qualified Blind Trusts" approved by the Committee on Standards of Offical Conduct and conain other “excepted trusts" need net
be disclosed, Have you excluded from this report datas of such a tut benefiting you, your spouse, or dependent child?
EXEMPTION—Have you excluded trom this report any other assets, “unearned income, transactions, olabilies ofa spouse or dependent child because they
rest all three tests for exemption?
CERTIFICATION — THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED
This Financial Disclosure Statement is required by the Ethics in Government Act of 1978, as amended. The Statoment will be available to any requesting person
upon written application and will be reviewed by the Committee on Standards of Official Conduct or its designee. Any individual who knowingly and wiltuly falsifies,
‘or who knowingly and willfully fails to file this report may be subject to civil penalties and criminal sanctions (See 5 U.S.C. app. 4, § 104 and 18 U.S.C. § 1001).
CERTIFY that the slatoments | havo made on this form
all attached. senedules. are true, complete and
[yest tote best of my anowidge and leSCHEDULE Ill — ASSETS AND “UNEARNED” INCOME wine Doraid Mbwze lle
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Asset and/or Income Source Value of Asset Type Amount of Income
igen (a) each asst nto for ivestment | a close of reporting yea. of Income Far cotrom ha
srpreesten oscar ger renetvave | it you use a valuation method ] Check ll columns that apply. | G2.net allow you to choose specie
Perey el ay ot meet oe seca ti | other than fair market value, | engox none tasset de not | neomn: For ak cher fasts, nate
Reumo ancl gardeatod sore as 3600 in | ot ar reas use the category of come by check
‘uneamed: Income curing ine year. For rental | Please specity jenerate any income during opr :
Broverty or ena, provide am adress. Pronde | an asset was sold ands incuded | fre ewendar year ‘9 | the appropriate box bolow. Dividends,
foifnames of any mutual unde. Fora ze.
directed IRA (re', one where you have the | omy because it generated income, 8 income. Chock “None” if ne
power to select ihe specie investments), | the value should be “None.” income was received.
Provide information on each asset In th
‘Sceeunt that exoseds the reporting ihreahols,
‘ang tho income earned for the acoaunt. For an
IA orratrement plan that fe rt selected,
fname the insthution holding the account and
provide ite value at the ond of the reporting
oriod. For an acive business thats net publicly
faded, in Block A state tne name of the
business, the nature of the business, and is
‘Boograpric lation. Fer adclionalinfermation,
Sethe Inetruetion booklet for the reporting
year
vy vtlvul vat oc x |x
Exclude: Your personat residence(s) (unless
here i rental wicomey. any debt owed to you
by your spouse, or by your oF your spouse's
chia, parent, oF sing’ any depostte Tota
'$5.000 0 lees in parsonal cavings accounts:
any feancial interes! in or income dorived Wom
US Government rerersant programs
Panneship come of Farm core)
{525,000,007 ~ $80,000,000
‘ver $50,006,000
If you 60 choose, you may indicate that an
stot of neome source is tat of your spouse
(SP) oF dependent child (06) oF is jal hela
GP). in the optional column en the Ter Tot
OWIDENDS
‘CAPITAL GAINS,
EXCEPTEDIBLIND TRUST
(other Type of income
|soncty: Fo Ex
‘Over $5,000,000
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For adltional assets and unearned income, use next page.
fs ce AtACAMEArSCHEDULE Ill — ASSETS AND “UNEARNED” INCOME name Dene iL fe. Mew Zetle ez
Continuation Sheet (if needed)
aLock a Block 8 ores Block BLOCKE
Asset andior Income Source Year-End Amount of Income ansactior
Value of Asset of ei
EXCEPTEDIBLIND TRUST
Otrer Type of income
(Specty)
‘$50,001 - $100,000
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This page may be copied more spaces required.
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