You are on page 1of 9
GNITED STATES HOUSE OF REPRESENTATIVES om. ___ HAND DELIVERED FINANCIAL DSCLOSURE STATEMENT FOR CALENOAR EAR 0s iF Foruse by Mentors, olan, andemplyete John N, Boozman ‘osuanve resource cenren 37 Champions Blva., Rogers, Ak 73758 OO MAY 11 PM 3: 92 _— RS Frnt He — RiGee tags MC? Fier anim oS San AERESAS mare ste HosstRepmerinne Since SE Empoyes_ —ronte ee 4 $200 ponaty shal be assensed “Termination Date: anyone who nore ip (oe TT ena DA reriraton 30 days ite PRELIMINARY INFORMATION — ANSWER EACH OF THESE QUESTIONS . 1, Dayar ose ae euro wna. sama o VE Oa ou yor sou, ra Gopodow Gidrecove wy Fama RE el wo] ERR ET |” Hyon comple an ch Soke i Dilan nat pen maaa ani wah VL ou Yu sano ope ci is apy Sua stn youtoraspeec opener, or ao he yes] wo] ‘oor. na oteticonet aren Beep | ites, complete and attach Schedule I | yes, Somplate and atech Scheale vat” — Die, or put oa ren ane oF Yi iyo hol ay etal gor no Sree feongeinuatantitibiegearepucsartwsy Yeal>] wo[]| tecateinacecmmemegostes cat won re tan x ig tach Sch SSeS, «Ll -L] Raeeeeees TVD yn, Wr ta aap oa Sectlaay Ma ertaraa ‘tye, completo and ssh Schedule, 2-0 Bit you, your cue, a dopant cris ve ay opoabie thot Enver todo) arg he ering pred at (tan trio St reg Each question in this part must be answered and the appropriate schedule attached for each “Yes” response. EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST INFORMATION — ANSWER EACH OF THESE QUESTIONS Basin a Soca nent tants os Pape cease ee memes retn Yoel] Ho EMT ee ty ob tse Recreraape rnc ote taspaneramwcansbenee val] wal] CERTIFICATION — THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED. ‘This Financial Disclosure Staloment i required by tho Ettcs in Government Act of 1978, as amended. Th Statement wil be availabe to any requasing poor upon writen appioaon and wl be rovowad by the Comet ‘on Standards of Ocal Conduct rs delgnee. Any incvdual whe knowingly ad wily ses, ot win imowingly and willy fis to flo this report may be subject fo civ penates and exminalsanctone (S02 8 U.S.C. app. 4 §104 and 18 USC. § 1001), RT = {CERTIFY tat to eistomenta Ihave made onthe fom baa atated sohodte aa" tune Sob Se 5-/-0@ ct to the Det of my knowidge and bee. ir ‘Bove’ oa ume) ay oor Your spe, Yar er pas ‘Sytner rere oreo eed mocks ‘Asset and/or income Source Valuo of Asset laonty (a each asst hao Investment | atcloe of reporting yo. pede ction 1 you use valvtion method ‘thor than fair market value, lesa epec the metod used Wan asset was 20ld and is Inoue ony becoieo ft gonratod Ineeme, the valu stad be-Nona” Locke ‘Type of Income Check al eats that apply Lowe blank asset it not generate any income dng {he slendaryoar ‘Amount of Income For etement plan o secourts that Gorn tow jou fo ohoose epoca [Seon You may wre Ae Income Fora ctor toot, dcae the apprépriate box “below mde: You peroneal rsgence) less pert allay eboute a ge cae enat0 51009801 -$5000000| ses. = #5960005 250001 oS ‘QUALIFIED BuO TRUST fect fe ac Patasicone Far nm ltr ype fae sronoot = 31600000 rer OO De, | ssn —svona00 [Someone L ample} |S na ein tna esr x | DwbEnos t jorthwest Natial Life | G Bdwards \evest_ Bank, | IN $= Treasury Te BG Govt Bond Fund Fa Roa For ddionsl assets and uneammed Income, ute next page. ~ Continuation Sheet (if needed) BLOCK ‘Asset andior Income Source 100K Amount of Income Value of Asset ATTepae]FT6 Typed oy xp GT]ABG Moni Bond Funa-ae ST]ABG Mani Bond Pund-otife 37|ABG Bguity Fund alamerite: SrlArvest Asset Mgmta0iK This poge may be copied M more space I required.