‘UNITED STATES HOUSE OF REPRESENTATIVES
FINANCIAL DISCLOSURE STATEMENT.
Period covered: January 1, 202i «Augers 1 det
FORM B
For use by candkdates and new employees
HAND DELIVERED
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Cane ee ives SET Bee Ne Deis 'A $200 penalty shall be assessed
‘Status ‘New officer or — against anybody who files more
ernie. Employing Ota: —— _| than 30 days late.
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PRELIMINARY INFORMATION — ANSWER EACH OF THESE QUESTIONS
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1. Oks you or your spouse have “eared” income (8.9. sales or ] 1. Dis you hes any reportable posts an or before te date
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Iiyee, complete end atach Schedule I ‘Wes, complato and attach Schedule V.
ose espe onlin car Da ps ct peri op an Dah
‘tio ladlny Zoe ian $16,000) Sunng the ropartng perkd?™ Senge scutes | mor yoors?
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Each question in this part must be answered and the appropriate schedule attached for each “Yes” response.
EXCLUSION OF SPOUSE, DEPENDENT, OR TRUST
‘Detallsregarcing “Qualiiod Bind Trusts" approved by the Co
‘sciosed. Have you excluded from this report detals of such
xt
[ON—Have you excluded from this report ary othor assets, “une
Because they meatal vee tests for exemotion? Do not anawer "yes" unlass you have fist consulted wih the Commitee on Standards of Ottical
Conduct.
INFORMATION — ANSWER EACH OF THESE QUESTIONS
‘Standards of Otfcial Conduct:
ng yo
ome, ransactionTat the souroe, type and amount of earned income from any inant Gy the U.S, Government) totaling $200 or
i . ‘only the source for other spouse eamed income
000. snpies below.
Exclude: Miliary pay (such as National Guard or Reserve pay), federal retirement programs, an
‘Source (include date of receipt for honoraria) ‘Type
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‘This page may be copied if more space Is required.SCHEDULE Il— ASSETS AND “UNEARNED” INCOME
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Value of Asset
Indicate value of asset at close
‘BLOCKS
‘Type of Income
method used
Wan asset was sold during te
reporting your and is included
only becatse kt generated
Tncome, the valve should be
No
Chock af columes tnt apply. For
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BLOCK
Amount of income
For reiroment plans oF accounts that do not
‘omer Type of income
SEEXOPRTEDELING BUSTIN
Current Year Preceding Year
Fal fal
[Dead F Rober Ts XB IB
Tee Anca Ger fore a Gi Aalod
For Shane ssect and uneardinsine,e Bt page