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UNITED STATES HOUSE OF REPRESENTATIVES 2007 FINANCIAL DISCLOSURE STATEMENT FORM A Foruse by Members, officers, and employees Georrrey Crark Daves Fananay ‘Member ofthe US. Slate House of Representatives Distt ‘aime Yaesrene ‘Officer or Employing Offos: Employes T_ Did you or your spouse have "eared Income (e.g. salaries or foes) of $200 oF more from any source inthe reporting period”? W?yes, complale and atch Schedule | I. Dig any individual or organization make a donation to charity in liou of paying you for a speech, appearance, or ariele Inthe ‘eporing porod? iM'yes, complete and attach Schedule I Vi_ Bid you. your spouse, or a dependent chil receive any feportable gift in the reporting perod (e., aggregating more ‘than $905 and not ctneruise exempt)? yes, complete and attach Schedule VI VIL Did you, your spouse, ora dependent child recsive any reponable avel or felmbureemerts for travel In the Teporing Jerod (worth more than 8305 from one Source)? ityes, complete and attach Schedule VI. HAND DEL; LEGISLATIVE RESOURCE CEN 7 BOTHAY -8 PHIa38 (5) LoneqworTh HOR, Wasningrn,DC 20515 (202)225-346S 2: 2 Tit CLERK ‘ang AS5 U.S. HOUSE OF REPRESENTATIVES. (tice Use Only} VERED ~ MC A $200 penalty shall be assessed against anyone who files more than 30 days late. ves[_] no BJ ves[7] nod Il, Did you, your spouse, or a dependent child receive “uneamed income of more than $200 inthe reporting period or hold any oportable asset worth more than $1,000 a the end ofthe period? ityes, complete and attach Schedule Il WV, Did you, your spouse, oF dependent chid purchase, sel (exchange any reportable asset in a transaction exceeding $1,000 during the reporting period? ityes, complete and attach Schedule Iv ¥, Did you, your spouse, or a dependent child have any reportable lity (more than $10 000) during the reporting pe tyes, complete and attach Schedule V. Vl, Did you hold ary reporabe psitons on or belore the date ofng in he cutrent calendar year’ ites, complete and attach Schedule VIN, 1X_ Did you have any reportable agrooment or arrangement win an outside entity? yes, complete and attach Schedule IX. ves[_] No[X] ves[_] of] Each ueenon in this part must be answered and the appropri jate schedule attached for each “Yes” response. EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST INFORMATION — ANSWER EACH OF THESE QUESTIONS ‘TRUSTS—Detais regarding “Qualiied Blind Trusts" approved by the Commitee on Standards of Oficial Conduct and certain other “excepted trusts” need not be disclosed. Have you excluded from this report details of such a tust benefiing you, your spouse. or dependent child? | wolx] EXEMPTION—Have you excluded from this report any other assets, “unearned! income, transactions, or Hablites of a spouse or dependent chiki because they meatal three tass for exemption? ves[_] of] 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 “978, as amended. The Statement 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 wilfuly falsfies, ‘of 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 statements I have made on this form all attached schedules are true, complete and [[IIPyrect to the best of my knowledge and belie. SCHEDULE | — EARNED INCOME List the source, type, and amount of eared income from any source (other than the filer’s current employment by the U.S. Government) totaling $200 or ‘more during the preceding calendar year. For a spouse, list the source and amourt of any honoraria: list only the source for other spouse earned income exceeding $1,000. Keene State ‘Slate of Maryland — For payments to charity in lieu of honoraria, use Schedule Hi me G2OFFI ) SCHEDULE III — ASSETS AND “UNEARNED” INCOME BLOOKA BLOCK B Block BLOCK Asset and/or Income Source Value of Asset ‘Type Amount of Income Idonty (a) each asset held for investment | at close of reporting year of Income For retemant plans or accounts that ee ee DUD at ine ond of tne reporting | {YOU use a valuation method | Check all columns that apply. porod, apa (0) a seares'at | other than fair market valve, | oheck nono" asset did not Frcome which ge ran $200 in | Glease specify the method used. ‘ {he catogory of come by checking “inured? stage cure yew Fo rer | method sed. | | generate any income during | the aapropnas wx below Oxideros propery or land, provide an adkress, Provigo | Wan ascot was sold and is incu ‘he calendar year oven ft weivested, shovid be listed ditectea'Ina (ce, ono where you have te | Only Because it gonerated income, fas income. Check "None” it no ower to selsct ine spectic wwestmonts), | the value should be “None.” ‘neome was received Brovige information an ach accel in ty Scour that exceeds fhe reporung ineshold Sng ie incom eared forte aocount Fora IRA or retroment plan that nt sal Sect, fame te insuution holding the aecount and Provide ts value atthe ord! of 5 wu vi in Block A etate tho namo of the the nature of the business, Ane ie ‘2e0graphic location. Fr addtional information, Seertne instruction booklet for the seporing your ‘Exclude: Your personal rosidenco()(unoss is rental income): any €ebt owed 10 Yoo by your spouse or by your Your spouses ‘hil, parent oF siting? any deposits ‘olaing $5,000 0 fess In porconal savings accounts fany financial interest In or como eorved ram US Government retcement programs. ‘$1,000,001 - $5,000,000 "$25,000,001 — $50,000,000 It you so choose, you may indicate that an ‘ebet or income source fe that of Your spouse {SP) of depondont chid (DG) orig jaimy Nels (BP), in the optional column ‘on the far left DIVIDENDS EXCEPTEDIBLIND TRUST '$100,00% - $250,000 ‘otner Type of Income (CAPITAL GAINS. ‘Mega Corp. Stock FERS Thrigt Savings Paw CANTON FEDERAL _C.UA, USAR Fedora) Saurnp Basle PERBLIC CONSULTING For additional assets and unearned income, use next page.