SB70-SSA2-SA2,210,1818 Residence Address: ....
SB70-SSA2-SA2,210,19 19Schedule “A"
SB70-SSA2-SA2,210,20 20Financial Disclosure
SB70-SSA2-SA2,210,2421 The following general categories of assets and liabilities are not all inclusive
22and if other assets or liabilities exist they should be listed. Assets should be listed
23according to which spouse has title (including assets owned by a spouse or the
24spouses with one or more third parties) and at their approximate market value.
SB70-SSA2-SA2,210,25 25Husband   Wife   Spouse (Name)   Spouse (Name)   Both Names
SB70-SSA2-SA2,211,1
1I.   Assets:
SB70-SSA2-SA2,211,22 A.   Real estate (gross value)
SB70-SSA2-SA2,211,33 B.   Stocks, bonds and mutual funds
SB70-SSA2-SA2,211,54 C.   Accounts at and certificates and other
5instruments issued by financial institutions
SB70-SSA2-SA2,211,76 D.   Mortgages, land contracts, promissory notes
7and cash
SB70-SSA2-SA2,211,88 E.   Partnership interests
SB70-SSA2-SA2,211,99 EL.   Limited liability company interests
SB70-SSA2-SA2,211,1010 F.   Trust interests
SB70-SSA2-SA2,211,1111 G.   Livestock, farm products, crops
SB70-SSA2-SA2,211,1212 H.   Automobiles and other vehicles
SB70-SSA2-SA2,211,1313 I.   Jewelry and personal effects
SB70-SSA2-SA2,211,1414 J.   Household furnishings
SB70-SSA2-SA2,211,1515 K.   Life insurance and annuities:
SB70-SSA2-SA2,211,1616 1.   Face value
SB70-SSA2-SA2,211,1717 2.   Cash surrender value
SB70-SSA2-SA2,211,1818 L.   Retirement benefits (include value):
SB70-SSA2-SA2,211,1919 1.   Pension plans
SB70-SSA2-SA2,211,2020 2.   Profit sharing plans
SB70-SSA2-SA2,211,2121 3.   HR-10 KEOGH plans
SB70-SSA2-SA2,211,2222 4.   IRAs
SB70-SSA2-SA2,211,2323 5.   Deferred compensation plans
SB70-SSA2-SA2,211,2424 M.   Other assets not listed elsewhere
SB70-SSA2-SA2,211,2525 II.   Obligations (total outstanding balance):
SB70-SSA2-SA2,212,1
1A.   Mortgages and liens