Short Form Financial Declaration Page 8

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_______________________________
$ _________________
$ ___________________
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_______________________________
$ _________________
$ __________________
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_______________________________
$ _________________
$ __________________
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On the lines below, please list any other assets or debts you have that have not been previously listed.
Assets such as furniture, jewelry, boats, assets held in your child’s name or joint tenancy with any other
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person, and personal loans owed to you. Debts such as medical bills and personal loans owed to others.
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Asset
Value of Asset
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___________________________________________
$ _________________
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___________________________________________
$ __________________
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___________________________________________
$ _________________
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Debt
Balance Owed on Debt
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___________________________________________
$ __________________
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___________________________________________
$ _________________
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___________________________________________
$ _________________
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___________________________________________
$ ___________________
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___________________________________________
$ __________________
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___________________________________________
$ _________________
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___________________________________________
$ ___________________
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___________________________________________
$ __________________
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