Personal Financial Statement Page 3
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1
2
3
4
5TOTAL
SCHEDULE 2 MORTGAGES AND DEEDS OF TRUST OWNED
NAME OF
LIEN
PROPERTY
PRIOR
HOW
MATURITY
UNPAID
DEBTOR
POSITION
VALUE
LIENS
PAYABLE
DATE
BALANCE
$
per
$
per
$
per
SCHEDULE 3 SECURITIES OWNED
EXCHANGE
TOTAL
PLEDGE
D?
NO. SHARES OR
N=NYSE A=AMEX
HOW
PRICE PER
MARKET
Y=YES
HELD
BOND AMOUNT
O=OTC
DESCRIPTION
TITLE IN NAME
CODE
SHARE
VALUE
N=NO
L=UNLISTED
OF
TOTAL
SCHEDULE 4 LIFE INSURANCE
INSURED
FACE AMOUNT OF
INSURANCE
BENEFICIARY
CASH
LOANS
POLICY
COMPANY
VALUE
TOTAL
Page 3 of 5
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