Beruflich Dokumente
Kultur Dokumente
Filer [] Member of the U.S. State: CA [] Officer Or Employing Office A $200 penalty shall-"
Status House of Representative District: 44 Employee HR MEMBER SERVICES be assessed against
anyone who files
+ Report Termination Date: more than 30 days i_
t [] Annual(May15) U Amendment [] Termination late.
i Type
i PRELIMINARY INFORMATION -- ANSWER EACH OF THESE QUESTIONS
i I I II T I I III
+ Did you or your spouse have "earned" Income (e.g., salaries or fees) of Did you, your spouse, or a dependent child receive any reportable gift In
f I. $200 or more from any source ln the reportlng podod? Yes [] No [] VI. ths raportlng podod (I.e., aggregaflng more than $285 and not otherwlse Yes [] No []
exempt)?
If yes, complete and attach Schedule I. If yes, complete and attach Schedule V!.
Did any Individual or organization make a donation to charity in lieu of Did you, your spouse, or a dependent child receive any reportable travel
m II. paying you for a speech, appearance, or article in the reporting period? Yes [] No [] VII. or reimbursements for travel In the reporting porlod (worth morethan Yes [] No []
$285 from one source)?
If yes, complete and attach Schedule II. If yes, complete and attach Schedule VII,
Did you, your spouse, or a dependent child receive "unearned" Income of Did you hold any reportable positions on or before the data Of filing In the
II1' more than $2001n the reportlng pedod or hold any reportable asset worth Yes [] No [] VIII. currsntcalendaryear? Yes [] No []
more than $t,000 at the end of the period?
If yes, complete and attach Schedule III. If yes, complete and attach Schedule VIII.
Did you, your spouse, or dependent child purchase, sell, or exchange any Did you have any reportable agreement or arrangement with an outside
IV. reportsbleassetlnetransactlonexcsedlng$t,000dudngthereporUng Yes [] No [] IX. entity? Yes [] No []
_erlod?
yes, complete and attach Schedule IV. If yes, complete and attach Schedule IX.
Did you, your spouse, or a dependent child have any reportable liability
V. (more than $10,000) during the reporting period? Yes [] No [] Each question in this part must be answered and the
If)tee, co, rnplete and attach Schedule V. appropriate schedule attached for each "Yes" response.
Trusts- Details regarding "Qualified Blind Trusts" approved by the Committee on Standards of Official Conduct and certain other "excepted
trusts" need not be disclosed. Have you excluded from this report details of such a trust benefiting you, your spouse, or dependent Yes [] No []
child?
Exemptions-- Have you excluded from this report any other assets, "unearned" Income, transactions, or liabilities of a spouse or dependent child
because they meet all three tests for exemption? Yea [] No []
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CERTIFICATION -- THIS DOCUMENT MUST BE SIGNED BY THE REPORTING INDIVIDUAL AND DATED I I
This Financial Disclosure Statement is required by the Ethics in Government Act of 1978, 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 willfully falsifies, or who knowingly and
wllfully falls tO file this report may be subject to civil penaiUes and criminal sancUons (See 5 U,S.C. app. 4, § 104 and U.S.C. § 1001).
II I I I
Certification Signature
of Repo.l_,;-u
,,,,,,,:,;,_1 Date(Month,Day,Year)
I CERTIFYthat thestatements
aretrue,complete I havemadeonthisformandall
andcorrecttothebestof myknowledge attachedschedules
andbelief. _' _)#_J_'_-
. I__ ,,_ " 13"_ II
t_p m
List the source, type, and amount of earned Income from any source (other than the flier's current employment by the U.S. Government) totalling $200 Ormore
during the preceding calendar year. For a spouse, list the source and amount of any honoraria; list only the source for other spouse earned Income exceeding
$1,000.
I I I
Source I I
Type Amount
AFTRA RETIREMENT FUND PENS ON $37,716
Asset and/or Income Source Year-End Type of Income Amount of Income Transaction
Identify (a) each asset held for Investment or production of Income with Value of Asset If other than one of the For retirement plans or Indicate If asset
a fair marketvalue excaedlng $1,000 at the end of the reporting period, listed categories, specify accounts that do not allow was purchased
and (b) any other asset or source of income which generated more than at close of reporting the type of Income by you to choose specific (P), sold (S), or
$200 in "unearned" Income during the year. For rental property or land, year. If you use a writing a brief description investments, you may writs exchanged (E)
provide an address. Provide full names of any mutual funds. For a self valuation method In this block. (For "NA" for Income. For all In reporting year.
directed IRA (I.e., one where you have the power to select the specific other than fair market example: Partnership other assets, Indicate the
Investments) provide Information on each asset in the account that value, please specify Income or Farm Income) category of Income by
exceeds the reporting threshold and the income earned for the account, the method used. If an checking the appropriate
For an IRA or retirement plan that is not self-directed, name the asset was sold and is box below. Dividends, even
Institution holding the account and provide Its value at the end of the Included only because if reinvested, should be
reporting period. For an active business that Is not publiclytraded, in it is generated income, listed as Income.
Block A state the nature of the business and its geographic location, the value should be
For additional information, see Instruction booklet for the reporting "None."
year.
ii ,J i , i ,
Report any purchase, sale or exchange by you, your spouse, or dependent child durlng the reporting year of any real property, stocks, bonds, commodltles futures,
or other securltles when the amount of the transaction or serles of transactions exceeded $1,000. Include transacUonsthat resulted In a loss. Do not report a
transaction between
I
you, your spouse, or your dependent
I
chlld, or the purchase or sale of your personal
I
llllIlll
residence, unless
I
It is rented out.i ii
SP,
DC, Type of
JT ,w,, i
Asset Transaction Date
,, ,,
Amount of Transaction
ALLERGAN, INC. P 07-10-02 $1,001 - $15,000
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
FIRST DATA CORP P 07.10-02 $1,001 - $15,000
Report any purchase, sale or exchange byyou, your spouse, Or dependent chlld during the reporting year of any real property, stocks, bonds, commodltles futures,
or other securltles when the amount of the transaction or series of transactlons exceeded $1,000. Include transactions that resulted in a loss. Do not report a
transactlon between you, your spouse, or your dependent child, or II
the purchase or sale of your personal resldence, IIIII
unless
IIIII
It Is rented out. IIII
SP,
DC, Type of
JT Asset Transaction ,,,
Date Amount of Transaction
SOUTHWEST AIRLINES P 07-10-02 $1,001 - $15,000
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
FIRST DATA CORP'IRA P 07-10-02 $1,001 - $15,000
Report any purchase, sale or exchange by you, your spouse, or dependent child during the reporting year of any real property, stocks, bonds, commodities futures,
or other securttles when the amount of the transaction or series of transactions exceeded $1,000. Include transactions that resulted In a loss. Do not report a
transaction between you, your spouse, or your dependent child,
I I
or
i
the purchase or sale
li
of your personal
i
residence, unless It Is rented out. I
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
ii ii i f
Report any purchase, sale or exchange by you, your spouse, or dependent child during the reporting year of any real property, stocks, bonds, commodities futures,
or other securities when the amount of the transaction or series of transactions exceeded $1,000. Include transactions that resulted In a loss. Do not report a
transaction between you,iiiii
youri i
spouse, or your dependent child, or the purchase or sale of your personal residence, unless it is rented out.
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
DC GALLAGHER ARTHUR J & CO. = 09-10-02 $11001- $15,000
Report any purchase, sale or exchange byyou, your spouse, or dependent child during the reporting year of any real property, stocks, bonds, commodities futures,
or other securities when the amount of the transaction or series of transactions exceeded $1,000. Include transactions that resulted in a loss. Do not report a
transaction between you, your spouse, or your dependent child, or the purchase or sale of your persona! residence, unless It Is rented out.
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
r =ll ii , i i i,
i ii i ill i i
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
,, , ,
Report any purchase, sale or exchange by you, your spouse, or dependent chlld durlng the mp0rtlng year of any real property, stocks, bonds, commodltlea futures,
or other securities when the amount of the transactlon or series of transactlons exceeded $I;000. Include transactions that resulted in a loss. Do not report a
transaction between you, your spouse, or your dependent child, or the purchase or sale of your personal resldence, unless It is rented out.
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
JOHNSON & JOHNSON S 11-06-02 $1,001 - $15,000
Repo_ any purchase, sale or exchange by you, your spouse, or dependent child during the reporting year of any real property, stocks, bonds, commodiUes futures,
or other securltles when the amount of the transactlon or serles of transactlons exceeded $I,000. Include transactlons that resulted In a loss. Do not report a
transaction between
I
you, your spouse, or your
II
dependent chlld, or the purchase or sale
I
of your personal residence, unless It is rented out.
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
i
Report any purchase, sale or exchange by you, your spouse, or dependent child during the reporting year of any real prop'erty,stocks, bonds, commodltles futures,
or other securlUes when the amount of the transaction or series of transactions exceeded $1,000. Include transactions that resulted in a loss. Do not report a
transaction between you, your spouse, or your dependent child, or the purchase or sale of your personal residence, unless It Is rented out.
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
[)C JOHNSON & JOHNSON S 11-06-02 $1,001 - $15,000
I
DC TORCHMARK CORP S 09-10-02 $1,001 - $15,000
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
DC FREDDIE MAC S 08-22-02 $1,001 - $15,000
i i , ,
Report any purchase, sale or exchange by you, your spouse, or dependent child during the reporting year of any real property, stocks, bonds, commodlUes futures,
or other securities when the amount of the transaction or series of transactions exceeded $1,000. Include transactions that resulted in a loss. Do not report a
transaction between you, your spouse, or your dependent child, or the purchase or saleI IIIof yourI personal residence, unless it is rented out.
I II
SP,
DC, Type of
JT Asset Transaction Date Amount of Transaction
ISHARES-IRA S 07-15-02 $50,001 - $100,000
ii i i i i i i • i i i
Identify the source and list travel Itinera_, dates, and nature of expenses provitlod for travel and travel.related expenses totalling more than $285 received by you,
your spouse, or a dependent child during the reporting period. Indicate whether a family member accompanied the traveler at the sponsor's expense, and the
amount of time, if any, that was not at the sponsor's expense. Disclosure Is required regardless of whether the expenses were relmburaed or paid direcUy by the
sponsor. Exclude: Travel-related expenses provided by federal, state, and local •governments, or by a foreign government required to be separately reported under
the Foreign Gifts and Decorations Act (5 U.S.C § 7342); political travel that Is required to be reported under the Federal Election Campaign Act; travel provided to a
spouse or dependent child that is totally independent of his or her relationship to you.
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