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UNITED STATES HOUSE OF REPRESENTATIVES FORMA pena + [ FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2006 __ For use by Members, officers, and employees HAND DELIVERED Michael C. Burgess, MD. a sesnunce over (4) : (Fut Name) : P.O. Box 292728 Lewisville, TX 75029-2728 ZO MAY 30 PH 4: 50 ML {Mailing Adéress) ayiime Talepho (Office Use Bolerenk, yj Member of the U.S. State: TX 1 Officer Or Employing Office 14 $200 ponalty shal House of Representatives pystict 76 Employee be assessed against paaaiaaaa nie aie ee anyone who files ‘Termination Date: ‘more than 30 days late. VES Did you or your suns Fava onrned income (2G, Saenas or Toe) TF ‘iyo yor spore or Gpmraent i Tee ay para GTA ‘otmore rom any pure nthe oper period? You ©] Wo gy Yb Bereta pads: epeatng mer thn oa ndot atone Yes") No omen yes, complete and attach Schedule : ifyon, compete and attach Schedule Vi Bid you, yo depen id recov any repoable vel Yos (-) No jy’ Vit orreimbursement for tava inthe roporting period (worth more thet Yes gj No [J fos rer one source)? if yes, compote and atach Schedule ifyen, complete and attach Schad Od you you spouse of «dependent oh race “unaared” income of > Bid yeu hot ary reportable poetons ono bor te date fing nhe |. more tan Sab ne reporngperod ord any reporabe mae worm Yes |) No [Wik curentatndnt year? Yes fyi No) Hyes, complete and attach Schedule VI ‘id you have ay reportable agreemert or arrangement with an ouside /. reportable saset ina anaacton exceeding $000 during the reporting OM ene Yor 7 No Hi period? yes, complete ond attach Schedule IV yes, complete and attach Schedule OK Each question in this part must schedule attached for each "Y¢ answered and the appropriate Detale regarding “Qualified Blind Trusts” approved by the Commities on Standards of Official Conduct and certain other “excepted trusts” need not be disclosed. Have you excluded from this report detalls of such a trust benefiting you, your spouse, or dependent __ chi Exemptions. Have you excluded from this report any ather assets, “uneamed™ income, transactions, or Hablies ofa spouse or dependent child because they meot all three tests for exemption? CERTIFICATION -- THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED ‘This Financial Disclosure Statement is requred bythe Etcs In Government Act 1876, at amended, The Slatoment wil be avaiable to any requesting person upon written application and wil be reviewed by the Committee on Standards of Official Conduct or ts designee. Any individual who knowingly and willy flafes, or who knowingly and willy i 0 fle this repor may be subject lo civ penalies and erminal sanctons (See §U.S.C, app. 4,§ 104 ang U.S.C. § 1001), Cariicaton CERTIFY that the eater are true, complete and correct to the best of my knowledge and belie. Name Michze! C. Burgess, M.D. SCHEDULE Ill - ASSETS AND “UNEARNED” INCOME ie ‘BLOCK A ‘BLOCK e BLOCK BLOCK D ‘BLOCK E Asset and/or Income Source Year-End Type of Income | Amount of Income | Transaction ‘dentity (a) each asset held or investment o production at income witha | Yalue of Asset | Creckallcolumns that] For rtiroment plans or Indicate i asset fairmarket valve exceeding $1,000 at te end ofthe reporing pariod, and apply. Check"None"it | accounts that do not allow} had purchases (b)any other asset or source of income which generated more than $200. | stclose of reporting | asset didnot generate any | you to choose spcifc (Ph sates (8), oF ‘nuneamos" income during the year, For renal propery o and, year. Hyou use = income during the Investments, younay wete | exchanges () Drovide an address, Provide full names of any mutual nds. Fora self | valuation methed other | calender year. Wother | "NA"for income. Forall | exceoding fdrectec IRA (one where you have the power to select the specific | thanfairmarsetvalve, | thanone ofthelisted | other assets, Indicate ne | $1,000 in {vestments} provide information on each asset inthe account that please specityihe | categories, specitythe | category of income by Teporting year. ‘exceeds the reporting Bweshold and the Income eamed fr the account, | methodused. fan | type of income by writing | ehecking the approprato For an IRA or retirement pian thats not selt-dvcied, ame the Geet was sold andis | abretdeserptionin tis. | box below. Dicends, even inatituton holding the account and provide is value atthe end ofthe | included only because | block. (Forexample: | H reinvested, should be reporting period. Foran aetve business that isnot publcy raded,in__| Itisgeneratedincome, | Partnership income or | lated a income. Check Bock A state the nature of the business and ts geographic location. For iue should be” | Farm Income) None” Ho income was ‘ditional information, aee Instruction Booklet forte reporting year. * earned. Exclude: Your personal residence(s} (unless there is rental income); any ‘dobt owed to you by your spouse, or by your or your spouse's child, parent, or sibing; any deposits totaling $5,000 or loss in personal Savings accounts; any financial interest in oF income derived from U.S. Government retirement programs. you s0 choose, you may indicate that an asset or income sourco Is that ‘of your spouse (SP) or dependent child (OC) or is jointly held (JT), n the ‘optional column on the far let. 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