SB907,,572572Print Name Here: .... SB907,,573573Residence Address: .... SB907,,574574Schedule “a” SB907,,575575Financial Disclosure SB907,,576576The following general categories of assets and liabilities are not all inclusive and if other assets or liabilities exist they should be listed. Assets should be listed according to which spouse has title (including assets owned by a spouse or the spouses with one or more third parties) and at their approximate market value. SB907,,577577Husband Wife Spouse (Name) Spouse (Name) Both Names SB907,,579579A. Real estate (gross value) SB907,,580580B. Stocks, bonds and mutual funds SB907,,581581C. Accounts at and certificates or other instruments issued by financial institutions SB907,,582582D. Mortgages, land contracts, promissory notes and cash SB907,,583583E. Partnership interests SB907,,584584EL. Limited liability company interests. SB907,,585585F. Trust interests SB907,,586586G. Livestock, farm products, crops SB907,,587587H. Automobiles and other vehicles SB907,,588588I. Jewelry and personal effects SB907,,589589J. Household furnishings SB907,,590590K. Life insurance and annuities: SB907,,5915911. Face value SB907,,5925922. Cash surrender value SB907,,593593L. Retirement benefits (include value): SB907,,5945941. Pension plans SB907,,5955952. Profit sharing plans SB907,,5965963. HR-10 KEOGH plans SB907,,5985985. Deferred compensation plans SB907,,599599M. Other assets not listed elsewhere SB907,,600600II. Obligations (total outstanding balance):