i: [Oningo StaTES HOUSE OF REPRESENTATIVES
+ [FINANCIAL DISCLOSURE STATEMENT
Period covered: Janvary 1, .004.- Decmu see. Y1,2004
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:
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‘SCHEDULE I— EARNED INCOME (INCLUDING HONORARIA) fe
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For addon assets and unearned income, ue net page.- SCHEDULE lIASSETS AND “UNEARNED” INCOME,
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Asset andlor Income Source
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‘This page may be coped i more space Is recur.SCHEDULE Il — LIABILITIES
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