Financial Disclosure Report Form Page 4

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Name (Last, First, Middle Initial)
Social Security Number
ADDITIONAL ENTRIES
SECTION 8: LEASED VEHICLES, BOATS, AIRPLANES, OTHER
8a. Codes
8b. Type
8c. Make
8d. Model/Year
8e. Plate or ID
8f. Year Leased 8g. Monthly Lease/
Number
Rental Payment
SECTION 9: OTHER ASSETS, U.S. AND FOREIGN
9a. Codes
9b. Description
9c. US/Foreign
9d. Year of
9e. Purchase Price
9f. Year-End Fair
Indicator
Purchase
or Other Cost Basis
Market Value
SECTION 10: MORTGAGES, LOANS
U.S. AND FOREIGN
(including installment and personal loans),
10a. Codes
10b. Type
10c. Name of
10d. US/Foreign 10e. Address of Creditor
10f. Original
10g. Year-End
10h. Monthly
of Loan
Creditor
Indicator
Balance
Balance
Payment
SECTION 11: OTHER LIABILITIES, U.S. AND FOREIGN
11a. Codes
11b. Type
11c. Name of
11d. US/Foreign 11e. Address of Creditor
11f. Original
11g. Year-End
11h. Monthly
of Liability
Creditor
Indicator
Balance
Balance
Payment
SECTION 12: ADDITIONAL INCOME/BANKRUPTCY
12a. Item Type
12b. $ Amount
12c. Explanation
SECTION 13: SAFE DEPOSIT BOX/COMMENTS
13a. Name of Institution
13b. Address of Institution
13c. Explanation (Optional)
SF 714 (5-05) Page 4 of 17

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