Financial Declaration Page 7

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In Whose
Holder
Asset
Name?
Current Value
(Name & Address)
Petitioner
Profit Sharing Plan
Respondent
Last 4 digits of acct number: _________
Both
$
Petitioner
Profit Sharing Plan
Respondent
Last 4 digits of acct number: _________
Both
$
Petitioner
Annuity
Respondent
Last 4 digits of acct number: _________
Both
$
Petitioner
Annuity
Respondent
Last 4 digits of acct number: _________
Both
$
Petitioner
Money Owed to Parties
Respondent
Both
$
Petitioner
Cash
Respondent
Both
$
Petitioner
Other
Respondent
(Describe)
Both
$
Face Value
Petitioner
Life Insurance
$__________
Respondent
Cash Value
Last 4 digits of acct number: _________
Both
$__________
Face Value
Petitioner
Life Insurance
$__________
Respondent
Cash Value
Last 4 digits of acct number: _________
Both
$__________
Financial Declaration
Approved Board of District Court Judges September 10, 2008
Page 7 of 11

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