Civil Cover Sheet Page 20
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22Checking Account:___________________________________________________________
Savings Account:____________________________________________________________
Certificates of Deposit:________________________________________________________
Real Estate
(Including Home): ___________________________________________________________
Motor Vehicle: Make _______________________________ Year __________________
Z
Cost $_________________________________
Amount Owed
Stocks & Bonds: ____________________________________________________________
Other: _____________________________________________________________________
_____________________________________________________________________
(f) DEBTS AND OBLIGATIONS (state as dollar amounts)
Mortgage: __________________________________________________________________
Rent:
__________________________________________________________________
Loans:
__________________________________________________________________
Other:
__________________________________________________________________
(g) PERSONS DEPENDENT UPON YOU FOR SUPPORT
(Wife) (Husband) Name: ______________________________________________________
Children, if any: _________________________________Age _______________________
_________________________________Age _______________________
_________________________________Age _______________________
_________________________________Age _______________________
Other Persons:
Name:_________________________________________________________________
Page 9 of 11
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Parent category: Business