Form 433-A - How To Prepare Form 433-A And Templates Page 4

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Section III. - continued
General Financial Information
14. Charge cards and lines of credit from banks, credit unions, and savings and loans. List all other charge accounts in item 28.
Type of Account
or Card
Master Card
Charge Card
Name and Address of
Financial Institution
BB&T
Exxon
Totals (Enter in Items 27)
D
Monthly
Payment
50.00
200.00
250.00
Credit
Umit
1,000.00
3,000.00
4,000.00
Amount
Owed
1,000.00
1,500.00
2,500.00
Credit Available
0.00
1,500.00
1,500.00
15. Safe deposit boxes rented or accessed (List alt locations, box numbers, and contents)
Deposit Box BB&T Lee St Charleston WV Box 345-Papers
16.
Real Property (Brief description and type of ownership)
a. 2 Story Range
b.
c.
17.Life insurance (Name of Company)
Met Life
Aenta
Physical Address
1536 Road Dr Charleston WV
Countv Kanawha
C
Co
Policy
Number
11111
24321
Type
Whole
/ Term
Whole
/ Term
Whole
Term
Face
Amount
20000.00
20000.00
Total (Enter in Item 23)
D
Duntv
untv
Available Loan
Value
0.00
0.00
$
0.00
18. Securities (stocks, bonds, mutual funds, money market funds, government securities, etc.):
Kind
Us Govt. Bonds
Charles Schwab Mutual Funds
Money Market Account
Quantity or
Denomination
20/S100.00
Current
Value
2,000.00
1,000.00
1,000.00
Where
Located
IRS
Brokerage Firm
Chase
Owner
of Record
Jason
Julie
Jason
19
Other information relating to your financial conditions. If you check the yes box below , please give dates and explain on page 4,
Additional information or Comments:
a Court proceedings
Yes
/ No
c
Repossessions
Yes
/
No
b. Bankruptcies
Yes
/ No
d. Recent sale or other transfer
Yes
No
of assets for less than full value

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