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Ethics Forms

Ethics Forms

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Published by Brian J. Amaral

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Published by: Brian J. Amaral on May 11, 2012
Copyright:Attribution Non-commercial

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05/11/2012

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LfG1SLATlVERESOURCECE'JT::"J:}
t,
f_(\
X
OriginalAmendment
2312JAN
13AM
10:58
u.s.
HouseofRepresentativesII2thCongressMEMBER/OFFICERPOST~TRAVELDISCLOSUREFORM
Thisformisfordisclosingthereceiptoftravelexpensesfromaprivatesourceformeetings,speakingengagements,fact-findingtripsorsimilarevents
in
connectionwithofficial.duties,Youneednotdisclosegovernment-fundedorpoliticaltravelonthisform,ortravelthatisunrelatedtoofficialduties.Thisformdoesnoteliminatetheneedtoreportallprivately-fundedtravelontheMemberorofficer'sannualFinancialDisclosureStatement.Inaccordancewithclause5ofHouseRule25,completethisformandfileitwiththeClerkoftheHouseofRepresentatives,B-I06CannonHouseOfficeBuilding,within15daysaftertraveliscompleted.TheClerkistomaketheseformsavailabletothepublicassoonaspossibleaftertheyarereceived.
Obtainthedollaramountsfromthesponsor;
if
exactdollaramountsareunavailable,provideagoodfaithestimate.
NameofMemberorOfficer(printortype):
Rep.WilliamOwens
NameofAccompanyingFamilyMember(ifany):
,-J_a,...n_e---,O..-w--,-e_n_s_
RelationshiptoMember/Officer:I/lspouseUChiid
D
Other(specify):DateofDepartureandDateofRetum:
12/27/2011-111/2012
Datesatpersonalexpense:Itinerary(citiesofdeparture-destination~return):
Taipel-Vancouver-Montreal
Montreal-LosAngeles-Taipei
Sponsor(s)(whopaidforthetrip):
ChineseCultureUniversity
Describemeetingsandeventsattended(attachadditionalpagesifnecessary):
Seeattacheditinerary
AttachedtothisformareEACHofthefollowing
(signify"yes"foreachitembycheckingthecorrespondingbox):
1.[{]
thePrivateSponsorTravelCertificationFormcompleted
by
tripsponsor,includingallattachments;2.
IZI
thePrivately-SponsoredTravelApprovalFormcompletedbytheMemberorofficer;
and
3.
0
theCommitteeonEthicsletterapprovingmyparticipationonthistrip.IrepresentthatIparticipatedineachoftheactivitiesreflectedinthesponsor'sagenda
(signify"yes"bycheckingbox):
ill
Ifnot,explain:
 
X
Original__Amendment
U.S.House
of
Representatives
112th
CongressMEMBER
I
OFFICERPOST-TRAVELDISCLOSUREFORM
Thisformisfordisclosingthereceiptoftravelexpensesfromaprivatesourceformeetings,speakingengagements,.fact-findingtripsorsimilareventsinconnectionwithofficialduties.Youneednotdisclosegovernment-fundedorpollticaltravelonthisform,ortravelthatisunrelatedtoofficialduties,Thisformdoesnoteliminatetheneedtoreport
sn
privately-fundedtravelontheMemberorofficer'sannualFinancialDisclosureStatement.
In
accordancewithclause5ofHouseRule25,completethisformandfileit
with
theClerkoftheHouseofRepresentatives,B~106CannonHouseOfficeBuilding,within15daysaftertraveliscompleted.TheClerkis
to
maketheseformsavailable
to
thepublicassoonaspossibleaftertheyarereceived.
Obtainthedollaramountsfrom
the
sponsor;
if
exactdollaramountsareunavailable,provideagoodfaithestimate.
NameofMemberorOfficer(printortype):
Rep.WilliamOwens
NameofAccompanyingFamilyMembifany):
JaneOwens'
Relationship
toMember/Officer:
Spouse
DCbild
DOther
(specify):_DateofDepartureandDateof
Return:
12/27/2011-1/112012
Datesatpersonalexpense:Itinerary
(cities
of
departure-
destination-
return):
Taipei~Vancouver-Montreal
Montreal-LosAngeles-Taipei
Sponsor(s)(whopaidforthetrip):
ChineseCultureUniversity
Describemeetingsandeventsattended(attachadditionalpagesifnecessary):
Seeattacheditinerary
Attachedto
thisform
are
EACH
ofthe
following
(signifY"yes"foreachitembycheckingthecorrespondingbox):
1.
III
thePrivateSponsorTravelCertificationFormcompleted
by
tripsponsor.includingallattachments;.
2.
0
thePrivately-SponsoredTravelApprovalFormcompleted
by
theMemberorofficer;
and
3.
[2]
the
Committee
01:).
Ethicsletterapprovingmyparticipationonthistrip.
I
epresentthatIparticipatedineachoftheactivitiesreflectedinthesponsor'sagenda
(signify
"yes"by
checkingbox):
0
Ifnot,explain:_
 
TRIPEXPENSES:
.Ir-..;_;_--~"----'-_;__;_,'-I-~-:-'
e-'~";_'
·:-·;-~;_:~_;"::-rtal-'-.
-io"-n"---'
Ir-~T-·.·o-.·t-~l-'-~~-o-.·d-:
-i~-g-E-:.X-··~-:·
-~s-:·es'-·:-.-..
rT~~-·-~~~:.·~~~e~e~...
~~!!;~beror
1.
$9566:10...
~780
t
t
,I
$70
r"'F"""o';;;'r"""ac"';';co"'-m';:'_;__pan-'-y"-in-'g"",,,.;_.
:';'1
"-$--'"95"'"6"-6-,'-1
-.-""''':'';''';_;;''':'';;'~..
1
~;~.o.·~.~.
~a.-.I-""",,"
".'.1~;:~."".'.".,,-_.."''''''
family
member:.
Other
Expenses
(dollaramount),Specific
NatureofExpenses
(e.g.,
taxi,
parking,registrationfee,etc.).
I
~;~beror..
JNA.
!
~;D;c:!~~~~g".
.~~
Icertifythattheinformationcontained
in
thisformistrue,
complete,
andcorrect
to
thebestof
my
knowledge,
1havedeterminedthatalloftheexpenseslistedabovewerenecessaryandthatthetravelwas
inconnection
with
mydutiesasaMemberorOfficerof
the
U.S.House
of
Repr~
and
would
not
createtheappearancethatIamusingpublicofficeforprivate~~
p
A,
SIGNATUREOFMEMBEROROFFICER:
f-::J",~
DATE:
~1-/3-1=1
V!lrsicmdate1/2011
by
CommitteeonEthics
2

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