UNITED STATES HOUSE OF REPRESENTATIVES Dc FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2005 | Foust 8” Members oe, an orga iS M10: 16 renaee [emee fe xlacny vue Bb West Sreeet Gav lem NY 121833 — 200" FBS 046 Epona Orem {A $200 penalty shall be assessed ‘against anyone who files more than 20 days tate, = oe Oem = PRELIMINARY INFORMATION — ANSWER EACH OF THESE QUESTIONS 7, ye yur stots have sarod hear (ap. eater or WE Boa esau, a dope cn ae my Pee erecta smarter poco” veal] nol] pees iaeg os eye o wo] [eee RESET” a wD Sacaea area dO | sec ale aoe sna dean (RSS a wo |. Did you, your spouse, or dapandent child purchase, sal, 0c, il you nave any reportable agreement or arrangement —— poakeeaes ve] nol rE pean “=k SEL op SRE nmen | EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST INFORMATION — ANSWER EACH OF THESE QUESTIONS ENS ea NN +O “i "XEON fave use tom ea ry oe abe sea Rene anata ron ‘howe tats or exon CERTIFICATION — THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED. “This Financial Discos to any requesting pon wton application signed. ay inde! who knowingly ani willy Tae, ‘wna knowingly and wily fast fo Ws report may be subject to ev penates and exminal sanctions (Se0 5 U.S.C. app 4, §104 and 18 U.S.C. § 1001), id al theched’ coheculoe tre fue, completa Sho} Kan s/uloe ovect tothe Boat f my noua and be(ctrer than the thors current employment by the US. Government) totaling $200 or ‘more during the preceding el id amount of any honor roe or athr spouse earned income 5900, list ho sour Gpem Isred [wsunsnce_ ke Couearssvon | 1539 = New Yoru Srare Retirement Syste Srte Rerinetour bere] 11863 & ew Yew, Garce Ore of (ar Arta arian | sanesauy | wh For payments to charity In leu of honoraria, use Schedime Aeron, Acwer | vg * SCHEDULE Il — PAYMENTS MADE TO CHARITY IN LIEU OF HONORARIA, List the source, ectvty (2. speech, appearance, o ate), date, and amount of ary payment made by the sponsor ofan event o a chartable organization in feu of an honoravium. A seperate confidential list of charts reelving sven payments must be fled drecty wit ho Commitos on Standards of Oficial ‘Conclut. An envelope for transiting the ist is includ in each Member's fing package. ‘Source ‘Activity Date ‘Amount Frans | Beato Aneten Ae, Wem, BE a os a : ao rz gai ‘a 50 ‘This page may be pled il more space ls equlred.