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UNITED STATES HOUSE OF REPRESENTATIVES FORM A root's 1 HAND DELIVERED FINANCIAL DISCLOSURE STATEMENT FOR CALENDAR YEAR 2006 For use by Members, officers, and employees LEGISLATIVE RESOURCE CENTER ean 2OOTHAY LPH A= 40 2301 Raybum HOB Washington, DC 20515 202.225.4001 ovr ee Ce Tad cue Member of the U.S. State: PA House of Representatives py.tict 92 Did you or you spoure have “earned” income (oj saves or Tees) SO ‘oreore Wom any soure athe porting period? yes, complete and attach Schedule | id any individual or organization make a donation to chart in eu of paying youltora speech, appuarance, or atl nthe reporting plod? HHyes, complete and attach Schedule t ‘id you, your spouse, oa dependent child ecsve “unearned” income of ‘more than 320 Inthe reporting perio or old any reportable asset worth ‘more than $1,000 atthe end of he period? ifyes, complete and attach Schedule I, ‘id you, your spouse, o dependent child purtags, sal or exchange ai agua seins voeston ceding 1.00 dg he reno [yon complete and atch Schedule V. ‘id you, your spouse, or dependent child have any reportable lib (more han $16,000 ering te reporting period and attach Schedule V. f Daytime Telephone: sOUbe Orin KSCAI/FIVES Flere Employing Office: ($200 perattystat | ) ernie: be assessed against |» ~ : anyone who files Termination Date cre than 30 days late. Did you, your sponan ora dependent Cn cove ary repoable Ge Yes ij No [-] Vt tereporing penoa{is:eogreuaing more tan $305 ana nat termite Yeg econel? fiver, complete and attach Schedule VL idyou, your sponsor a dependent child recive ary repartee or Yeo [] No ‘eimbursemens for wavlinthereprong pvod (wor martha S305. Yes qo @ ‘from one source)? ifyes, complete and attach Schedule Vi ti ‘id you old any epee posions ono befor the date of ign the Yoo i No [] Vik eavenscaendaryar? vee tyes, complete and attach Schedule VI ‘Did you have any reportable agreement or arrangement with an outside Yor [] Noy x ene Yee tyes, complete and attach Schedule IX. ‘Yes ( No] Each question in this part must be answered and the appropriate schedule attached for each "Yes" respons EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST INFORMATION -- ANSWER EACH OF THESE QUESTIONS Trusts Drala regaring "Qualified Blind Truss" approved byte Conic on Standards of Oficial Conduct and catan other exceplod yy {tute need not be etosee. Have you encase rom is rpor Seale such aust netting you your epows, or dopenaamt Y0% (NOW child? Exemptions Have you excluded from this report any other assats, “unearned” income, transactions, or liabilities ofa spouse or dependent child because thoy moet all three teste for exemption? Yee (Nol) CERTIFICATION -- THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED “This Financial Disclosure Statements required by the Eris in Goverment Act of 1078, as amended. The Statement wil be avalabie to any requesting person upon written _appleation and ibe reviewed by the Committ on Standards of Offeal Conduct o is designee. Ary individual who Knowingly and willy false, cr who keowingly and willy {als to file this report may be subject to civil penalties and criminel sanctions (See 5 U.S.C. app. 4.§ 104 and U.S.C. § 1001) Conacotor Date Wont, Day, Year) | CERTIFY that be statements | have made on his frm anda atached schedules are rus, complete and correct to the best of my knowledge and belie. §-2- 07 SCHEDULE | - EARNED INCOME oe Page 20f 5 [List the source, type, and amount of earned income from any source (other than the fler’s 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; list only the source for ather spouse earned income exceeding $1,000. ‘Spouse Salary SCHEDULE Ill - ASSETS AND "UNEARNED" INCOME. Name Chaca Fattah Page 3.of 5 BLOCKA BLOCK BLOCK Block Asset and/or Income Source Year-End | Type of Income | Amount of Income ‘dent (a) each asset hold for investment oF production ofincome with | Value of Asset For retirement plans or stccounts that do not allow ‘and (b) any other asset or source of income which generated more than | at close of reporting you to choose specific $200 in “unearned” income during tha year. For rental property or land, | year. Ifyou use a Investments, you may write ‘provide an address. Provide full names of any mutual funds. Fora self | valuation mathod other "NA" for income. For all, than fale market value, other assets, indicate the please specify the eatagory af income by ) ‘exceeds the reporting threshold and the income earned for the account. | method used. fan | ype of income by writing | checking the appropriate For an IRA oF rotrement plan that is not solfirected, name the asset was sold andis| | a brief description in this | box below. Dividends, even Institution holding the account and provide its value atthe and of the | included only because | block. (For example: roinvested, should be reporting period. For an active business that isnot pul itis generated income, | Partnership income or | listed as income. Check Exclude: Your porsonalresidence(s) (unless there is rental income}; any ‘debt owed to you by your spouse, or by your or your spouse's chi ‘parent, oF sibling: any deposits totaling $5,000 of less in personal ‘savings accounts: any financial interest in or income derived from US. ‘Government ratrement programs. {you s0 choose, you may indicate that an asset or income source is ‘that of your spouse (SP) or dependent child (DC) ori jointly held (JT), in the optional colurmn on the far laf the value should be | Farm Income "None." ‘SP GE Common Stock $100,001 - Other: 401k NONE $250,000 s PA State Employee Retirement $50,001 - Other: Pension $2,501 - $5,000 NIA System $100,000 reported as earned income