Financial Statement Of Debtor (Submitted For Government Action On Claims Due The United States) Page 5

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54. Do you or your spouse own a computer, Blackberry or Palm pilots?
Yes
No
55. Do you maintain an Ebay account?
Yes
No
If yes, provide information including each and every Ebay user name/id utilized, your Ebay seller profile information, the email and physical address
provided by you on all accounts.
ITEMS WHICH MIGHT AFFECT FUTURE ASSETS
56. Are you involved in a lawsuit in which you might receive money or something of value?
Yes
No
If yeas, state where the suit is filed and what it involves: (Include Court number and caption)
57. Are you a Trustee, Executor or Administrator of an estate?
Yes
No
If yes, give details:
58. Is anyone holding money on your behalf?
Yes
No
If yes give details:
59. Is there any likelihood you will receive an inheritance?
Yes
No
If yes give specific details:
60. Have you sold or transferred any property, including real estate or personal property, during the past six years?
Yes
No
If you have give specific details:
61. Are your wages and/or those of your spouse under a garnishment at this time?
Yes
No
If yes, give specific details:
62. Are there outstanding unpaid judgments against you for any debts other than this one?
Yes
No
If yes, give specific details:
63. Do you owe large medical bills?
Yes
No If yes, give specific details and attach copies of the bills:
64. Do you receive or under any circumstances, expect to receive benefits from any established Trust, From a Claim for Compensation of Damages, or from a
Contingent or Future interest in Property of any kind?
Yes, Explain Below
No
5

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