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,,578578I.   Assets
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,,5975974.   IRAs
SB907,,5985985.   Deferred compensation plans
SB907,,599599M.   Other assets not listed elsewhere
SB907,,600600II.   Obligations (total outstanding balance):