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LEGISLATIVE RESOUROEEEN 2007 MAY 15 AMI: S4 UNITED STATES HOUSE OF REPRESENTATIVES. FORMA Eee FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2006 For use by Members, officers, and employees NORMAN D. DICKS (FaNamey 2467 RAYBURN HOB WASHINGTON, DC 20515 5-5916 (Maling Adress) cayime Tetpione Geeice OF Tue cutie, S. HOUSE GF REPRESENTATIVES DELIVERED (Olfice Use Only) iD ‘Member of the U.S. State: WA’ 1) Officer Or [Employing Ottice: ‘$200 penalty shall House of Representatives pisrict og Employee ‘be assessed against ————— anyone who files more than 30 days. late. "id you or your spouse have “eared Incowa ogy slaroe fos) T6200 formare tom any aoures nthe reporting prod? Yos (No [1] yes, complote and attach Schedulo |. ‘id any indivi or organization make a donation to chara ou o pag 1. Soutora peach pearance, a arlene pong period? Yoo | No (| M™ saimburnerents yes, complete ang attach Schedule I. {fyes, compote and attach Schedule Vil tat yur apc peo cee ued” come ‘yee ay peri pita on bts Ss TRING De iu. Socaurseincmetgprosrvocunrnstascttom Yon gj No (7) Mh comunity? ve 11 9 isn Somple nd atch Seneca = sys, complet and aah Schedule gia oe of pean CG Tas of NaF ye Fave pra rer or range wn a abe . grat tins anacuonenseang sam angtereprg” You i No [| eye Yes 5] No __Fiyes; complete and attach SeneduloV. : tyes, comploto and attach Schedule I. ‘id yeu, your spouse, os dependent chil nave ay eporaie oy (ore than 10,000) ring te reporting period? Yes No ¥} Each question in this part must be answered and the appropriate compte and attach Schedule V. schedule attached for each "Yes" response. Trusts: Detats regarding “Qualified Blind Trusts” approved by the Commitee on Standards of Official Conduct and certain her "excepted trusta® need not be disclosed, Have you excluded from thie report detalls of such a trust beneiing you, your spouse, or dependent Y@* [_) cole? Exemptions— Have you excluded irom this report anyother assets, “unearned income, transactions, o abilities ofa spouse or dependent child ‘bocause they most al trae test for exemption? CERTIFICATION -- THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED “Tis Financial Disclosure Statements required by th Ethics in Gavamment Act of 1978, as amended. The Statement wil be avallabis fo any requosing person upon wien Zppieation and wil be evened by he Commitee on Standards of Oficial Condit or ts desgnee. Ay inidual who krowogly and wily fasts, or who Knowingly and ‘nay fae ole ti eport may be subject to cl penaies and crmina sanctons (See 5 U.S.C. app. 4.§ 104 and US.C. § 1001), Conieaton ‘ignatre of Reporng neice | CERTIFY thatthe statements | have made on this fom anda attached schedules De ‘ate tue, complete and correct ot best of my Knowledge and belt nf. | » SCHEDULE | - EARNED INCOME Name NORMAN D. DICKS | Page 2ot 6 [List the source, type, and amount of earned income from any source (other than the filers current employment by the U.S. Government) totaling $200 or more |during the preceding calendar year. For a spouse, list the source and amount of any honoraria; ist only the source for other spouse earned income exceeding [s1,000. US Capitol Historical Society Spouse Salary » SCHEDULE Ill - ASSETS AND "UNEARNED" INCOME. BLOCK A LOCKE BLocKe BLOCK D BLOCKE Asset and/or Income Source Year-End ‘Type of Income | Amount of Income | Transaction ‘entity (a) each asset held fr investment or production of income with | Yalue of Asset | Cheekall columns that | For retirement plans of Indleate asset fal market value exceeding 1,000 a the end of the reporting period, apply. Check "None" it | accounte that do not allow | had purchases ‘and (o) any oer agset or source of income which generated more tan | atcloso of roporting | asset did not generate | you to choose speciic (@), sales (6), oF $200 ir "unearned" Income during the year. For rental propery or land, | year. Ifyou use a ‘anyincome during the | Investments, you may write | exchanges (E) provide an address. Provide fll names of any mutval funds. Fora seit | valuation method falendar year. Wother | “NA"for income. Forait | exceeding Sirected IRA (Leone where you have the power to velect the specie | atherthan fair market | than one ofthe ated | other assets, indicate the | $1,000 in Investments) provide Information on each asset inthe accourt that value, please specity | categories, speciy he tegory: reporting veer. ‘exceeds te reporting threshold and the income eared forthe ‘the method used. an | type ot income by writing account. Foran IRA or retirement plan thet le not self-directed, name | asset was sold and is | bre! description in this. the inattution holding the account and provide te value atthe end of | Included only because | lock. (For example: | ifrelnvested, should be ‘the reporting period. For an active business that i not publicly traded, | {tls generated income, | Partnership Income or | listed as income. Check in Block A state the nature of the business and ite geographic location, | the value shoul be None" ino income was For aditional information, ee instruction bookiet fr the reporting "None year. Exclude: Your personal residence(s) (unless there ie rental Income}: “any debt owed to you by your spouse, oF by your or your spouse's child, parent. or elbling: any deposits totaling 65,000 or lees in personal Savings accounts; ay financial Interest in or Income derived rom U.S. Government retirement programs. Ityou so choose, you may indiate that an asset or Income source is ‘that of your spouse (SP) or dapendont ehils (0) or Ia olny held (JT), In the optional column on the fr let SP Lincoln Life - AFIS Growth $15,001 - DIVIDENDS $2,501-$5,000 | Other Retirement annuity $50,000 P.O. Box 2340, Fort Wayne, IN 46801 = sP Lincoln Life -AFIS Intemational $15,001 - [pivipenps —_—| $2,501-$5,000 [other | Retirement annuity $50,000 | | P.O. Box 2340, Fort Wayne, IN o 46801 - ae ee sP Lincoln Life - NB Mid Cap Value " $15,001 - | DIVIDENDS 501 -$5,000 | Other Retirement annuity $50,000 : P.O. Box 2340, Fart Wayne, IN 46801