Page 3 of 8
Section 3
Personal Asset Information
(Continued)
Real Estate (Enter information about any house, condo, co-op, time share, etc. that you own or are buying)
Property Address
Primary Residence
(Street Address, City, State, ZIP Code)
Yes
No
Date Purchased
County and Country
Date of Final Payment
How title is held
Description of Property
(joint tenancy, etc.)
Current Market Value
Minus Loan Balance
(Mortgages, etc.)
$
X .8 = $
– $
(Total Value of Real Estate) =
(5a) $
Property Address
Primary Residence
(Street Address, City, State, ZIP Code)
Yes
No
Date Purchased
County and Country
Date of Final Payment
How title is held
Description of Property
(joint tenancy, etc.)
Current Market Value
Minus Loan Balance
(Mortgages, etc.)
$
X .8 = $
– $
(Total Value of Real Estate) =
(5b) $
Total value of property(s) from attachment [current market value X .8 minus any loan balance(s)]
(5c) $
Add lines (5a) through (5c) =
(5) $
Vehicles
(Enter information about any cars, boats, motorcycles, etc. that you own or lease)
Vehicle Make & Model
Year
Date Purchased
Mileage
Name of Creditor
Date of Final Payment
Monthly Lease/Loan Amount
Lease
Loan
$
Current Market Value
Minus Loan Balance
(Mortgages, etc.)
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
(6a) $
=
is leased, enter 0 as the total value)
Subtract $3,450 from line (6a)
(6b) $
(If line (6a) minus $3,450 is a negative number, enter "0")
Vehicle Make & Model
Year
Date Purchased
Mileage
Name of Creditor
Date of Final Payment
Monthly Lease/Loan Amount
Lease
Loan
$
Current Market Value
Minus Loan Balance
(Mortgages, etc.)
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
(6c) $
=
is leased, enter 0 as the total value)
If you are filing a joint offer, subtract $3,450 from line (6c)
(6d) $
(If line (6c) minus $3,450 is a negative number, enter "0")
If you are not filing a joint offer, enter the amount from line (6c)
Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)]
(6e) $
Total lines (6b), (6d), and (6e) =
(6) $
433-A (OIC)
Form
(Rev. 3-2017)
Catalog Number 55896Q