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i D STATES HOUSE OF REPRESENTATIVES FOHMB

FINANCIAL DISCLOSURE STATEMENT For use by canciidatou f
Z and naw employees 10
Period Covered: January 1, ~ PQS'- APRIL 3.0C^>
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5t
Filer
Status
s Candidate tor the
House ol Representatives
Stale: OJA
Dislrict — i .
Datoof
Election: yHgfe Check If
Amendment
A $200 penalty s h a l l b e a s s e s s e d
against anybody w h o (lies m o r e

D New antcer or
employee Employing Office: - D than 30 days late.

In all sections, please type or print clearly In black Ink. (M4, \ 0* (c

PRELIMINARY INFORMATION — ANSWER EACH OF THESE QUESTIONS

I. Did you or your spouse hove 'earned* income (e.g., salaries or IV. Did you hold any reportabla positions on or before the dele
fees) ol $200 or more from any source in the reporting period?
If yes, complete and attach Schedule I.
Yes ( 2 NoQ ot filing in the current calendar year or In the prior too years? Yesg] NoQ
If yes, complete and attach Schedule IV.
II. Did you, your spouse, or a dependent child receive ■unearned"
income of more than (200 in the reporting period or hold any V. Did you have any reportabla agreement or arrangement
repor table asset worth more than $1.000 at the end ol the period? Yesg] NoQ with an outside entity?
If yea, complete and attach Schedule V.
Yes Q No£3
If yea, complete and attach Schedule IL
111. Did you, your BPOUBB, or a dependent child have any report- VI. Did you receive compensation of more than $5,000 from
able llobflty (more than $10,000) during the reporting period?
It yes, complete and attach Schedule III. Yesg] NoQ a single source in the lab prior years?
II yes, complete and attach Schedule VI.
Yea [ No£

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

THUST8—Details regarding "Qualified Blind Thjsts" approved by the Committee on Standards of Official Conduct and certain other "axcepted trusts" ^_^
need not be disclosed. Have you excluded from this report details of such a trust benefiting you, your Bpouse, or a dependent child? (See Instructions, y M T ^ jvjj"

EXEMPTION—Have you excluded from this report any other assets, "unearned" income, transactions, or liabilities ot a spouse or dependent child
because they meet all three tests for exemption? Y e a [ ] Nofc}

CERTIFICATION —THIS DOCUMENT MUST BE SIGNED BYTHE REPORTING INDIVIDUAL AND DATED
This Financial Disclosure Statement is required by the Ethics In Government Act of 1978, as amended. Tho Statement will be available to any requesting person upon written
application and w i l be reviewed by the Committee o n Standards of Official Conduct or its designee. A n y individual who knowingly and willfully falsifies, or who knowingly and
willfully fails to file this report may be subject to civil penalties and criminal ^motions {Seo 5 U,S.C/€pp. 4, § 104 and 18U.S.C. § 1001).
CwUII cation Signature ot 0 * 1 * (Uano,, Dty. nan
I CERTIFY that the statements I have made on this form
and all attached schedules are true, complete and
c o n e d to the best of my knowledge and belief. \JS A$ a&o(c>
 ">

Name [})\)U$lti Page iL*k_

SCHEDULE I—EARNED INCOME (INCLUDING HONORARIA)

List the source, type, and amount of earned income, including honoraria, from any source (other than your current employment by the U.S. Government) totalling
$200 or more during the current year to the filing date and, separately, the preceding calendar year. For a spouse, list the source and amount of any honorana;
list only the source for other spouse earned income exceeding $1,000.
^OC Amount i^cj
Source (include date of receipt lor honoraria) Type Preceding Year
Current Year to Filing
XYZ Corporation, Houston, Texas Salary $8,300 $28,450
First Bank & Trust. Houston, Texas Director's Fee $400 $3,200
Examples:
XYZ Trade Association, Chicago. IL. (Rec'd Dec. 2) Honorarium 0 $1,000
Harris Countv. Texas. Public Schools Spouse Salary NA NA

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M \f 0.0,000 -5"S.VO0
P$«ACrM/VrftlC pRaQ-e<&lc*)AL. SMVIUA.

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SCHEDULE II — ASSETS AND "UNEARNED" INCOME
■ ~

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BLOCK C BLOCKD
BLOCKA BLOCKB

Value of Asset Type of Income Amount of Income

Asset and/or Income Source
Identify (a) each asset held tor investment or
production of Income with a fair marks! value
exceeding $1,000 at the end of the reporting
period, and (b) any other asset o r source of
income which generated mora than $200 In
"unearned" income during the year. For rental
property or land, provide an address. Provide
full names of any mutual funds. For a self-
directed IRA (i.e., one where y o u have the
power to select ihe specific Investments),
provide information on each asset in the
account that exceeds the reporting threshold,
and the income earned for ihe account. For an
IRA or retirement plan that Is not self-directed,
name tha institution holding the account and
provide its value at the end of the reporting
period. For an active business that Is not
publicly traded. In Block A state Ihe nature o l
tha business and its geographic locailon. For
additional Information, sse the Instruction
booklet for the reporting year.
at close of reporting period.
II you use a valuation method other
than fair market v n l u e , please
specify the method used.
If an asset was sold and Is Included
only because it generated income,
Ihe value should be "None.'
For retirement plans or accounts (hut d u
Check all that apply.
not allow you to choose specific
Leave b l a n k if a s s e t d i d not investments, you may write "NA" for
generate a n y Income during income. For an other assets, indicate the
category of Income by checking the
the r e p o r t i n g period.
appropriate box below. Dividends, even
If reinvested, should be listed as Income.
C h e c k " N o n e " if an asset d i d n u t
generate any income tor a reporting year.
Current Year Preceding Year
■r- i | in iv v VI VII VII IX X XI
I II in IV V VI VII VIII IX XI

Exclude; Your personal residence(t) (unless

there la rental Income); any debt owed to you
by your spouse, or by your or your spouse's
child, parent, or sibling; any deposits totaling
$5,000 or less in personal savings accounts;
any linancial interests in or Income derived 8
1
from U.S. Government retirement programs. m S3
If you no choose, y o u may Indicate that an 8
asset or Income source Is that <A your spouse 8 8 18 8
(SP) or dependent child (DC) or Is jointly held
(JT), In the optional column on the far left. Is !

SP. SP Mega Corp. Stock X

DC, Bxamplos: |3imon a; Schuster indefinite! Royal las
JT 1st Bank of H«duc»h, KY account*!

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F o r a d d i t i o n a l assets and unearned i n c o m e , use next page.

 Apr 25 06 02:31p Victoria Wells Wulsin 513-984-9257 p.4

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3 51-51,000 a
o $1.001-$15,000 O
V
V $15,001-550,000 O
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X V ^ v
B3
X V $50,001-5100.000 m
—
H
v $100,001-5250,000 TI
$250,001 - $500,000 ffi
$500,001-51,000.000 I
$1.000.001 -S5,0Oa,0OD -
$5.000.001-$25,000,000 «•
$25,000,001 - $50,000,000 X
1 Ovw $50,000,000 r
-V, ■ < -»< ^ X -x ■a* X X y DIV1D6NDS
REMT
INTEREST
^ . -Tk * 7<, * •y * "X V ■>r CAPITAL GAINS
Y EXCEPTED TRUST
QUAUFIED BLIND TRUST
1
Other Typo of Irtoome
(Sp«cfly)
f
Njonc -
S1-K0O =
■ ^
"> - < "V -v * * >r ~x - * ~x * $201-51.000 £
$1,001-$2500 <
$2501 -$6,000 <
$5,001 -$15000 £
■ S15X0I -$50,000 £
Ko.OOl -U60.OOO <
I
i 1100.001 - $ i . 000.000 s
r
51,000,001 -$5X00JXX x
Ow* $5,000,000 a
Nona

. $1-$20Q =
Is
- * ■ - :

X ■X" •v ~K X X $ 2 0 1 - $1X00 =
-^ v -i
$1.001-J2500 2
$2.501-S5.000 <
$6,001-SI 5,000 £
$15,001 - $50,000 S I
$80,001 -$100,000 S>
$100,001- $1,000X00 s 1
I ' $1,000,001 -$6.000000 X
O«fS6,000.000 2
-1 1
 Name l^\)LS/AJ Page 5M
SCHEDULE III — LIABILITIES
Report liabilities of over $10,000 owed to any one creditor at any time during the reporting period by you, your spouse, or dependent child. Mark the
highest amount owed during the reporting period. Exclude: Any mortgage on your personal residence (unless there is rental income); loans secured by
automobiles, household furniture, or appliances; and liabilities owed to a spouse, or the child, parent, or sibling of you or your spouse. Report revolving
charge accounts only if the balance at the close of the previous calendar year exceeded $10,000.
Amount of Liability

SP,
DC.
JT
Creditor Type of Liability
B

a8
§8"
»- a
88
88
So­
rt
i
§§.
riw
53 • S
Example: | Flrsi Bank of Wilmington, Delaware Mortgage on 123 Main SlreX, Dover, Dal
< C
?T tOe^&ANCO rVxa^y ClMCiA. 3poeii 'OhMQ *

SCHEDULE IV — POSITIONS
Report all positions, compensated or uncompensatad, held on or before the date of filing during the current calendar year and In the two prior years as
an officer, director, trustee of an organization, partner, proprietor, representative, employee, or consultant of any corporation, firm, partnership, or other
business enterprise, any nonprofit organization, any labor organization, or any educational or other institution other than the United States.
Exclude: Positions held in any religious, social, fraternal, or political entities; positions solely of an honorary nature; and positions listed on Schedule I.

Position Nam» of Organization

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fiecz&toy & fay
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Use additional sheets If more space Is required.
 *~ -/^\

Nsm« IOIOLS/AJ Page iaJt

SCHEDULE V—AGREEMENTS
Identify the date, parties to, and general terms of any agreement or arrangement with respect to: future employment; a leave of absenceduring ^ j S ^ ^ S C I ^ S .
service: continuation or deferral of payments by a former or current employer other than the U.S. Government; or continuing participation In an employee welfare or Den
eftt plan maintained by a former employer, _ .

Date Parties To Terms of Agreement

SCHEDULE VI—COMPENSATION IN EXCESS OF $5,000 PAID BY ONE SOURCE

Report sources of such compensation received by you or your business affiliation tor services provided directly by you during the two prior years.This Includes the names
of clients and customers of any corporation, firm, partnership, or other business enterprise, or any nonprofit organization If you directly provided the services generating
a fee or payment of more than $5,000. Exclude: Payments by the U.S. Government and any information considered confidential as a result of a privileged relationship
recognized by law.

Source (Name and Address) Brief Description of Duties

Example: ] DoeJones &^3rnHh, Hometown, Homestale Accounting services

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