Form Cd Lo-14b - Statement Of Financial Condition For Individuals Page 2

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CD LO-14B (Rev. 02/03)
Page 2
SECTION IV – ASSET S
22. Cash
TOT AL (Enter also on Pag e 3, Item 30- A)
$
23. Bank or Cred it Union Accounts (Checking, Savings, Certificate of Deposit, etc.)
Name of In stitution
Account Number
T yp e of Account
Balan ce
$
TOT AL (Enter also on Page 3, It em 30-B) $
24. Bank Credit Card s (Visa, MasterC ard, Discover, Am erican Express, etc.)
Credit
Amount
Cr edit
Nam e of Issuer
Account Number
Limit
Owed
Availab le
$
$
$
TOT AL (Enter also on Pag e 3, Item 30-C)
$
25. Securities (Stocks, Bonds, Mutual Funds, IRA, Government Secur ities, Money M arket Funds, etc.)
Quantit y or
Curr ent
T ype
Issuer
D enomination
Value
$
TOTAL (Enter also on Pag e 3, Item 30-D)
$
26. Real Propert y (Personal Residence, Vacation or Second Hom e, Investm ent Propert y, Unimproved Land, etc.)
Current Market
Amount
Equit y In
D escription
Address
Value
Owed
Propert y
$
$
$
TOTAL (Enter also on Pag e 3, Item 30-E)
$
27. Vehicles – Excluding Leased Vehicles (In cluding Motorhomes, Campers, Motorcycles, Boats, Trailer s, et c.)
Tag
Current Mar ket
Amount
Equit y In
Description
Make
Model
Year
Number
Value
Owed
Vehicle
$
$
$
TOT AL (Enter also on Pag e 3, Item 30-F)
$
28. Other Assets
Current or
Current or
Appraised Value
Appraised Value
Notes Receivable
$
Timber , Miner al or Drilling Rights
$
Cash Surr ender Valu e of Life In surance
Pat ents or Cop yrights
Judgments or Settlements Receivable
Other (Sp ecif y)
Vested R etirem ent Account
Collectables, Antiques or Art work
TOTAL (Enter also on Pag e 3, Item 30-G)
$

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