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<br />200809274 2~~68 <br /> <br />A Checking Account? $ <br /> <br />Certificates of Deposit? $ <br /> <br />Money Market Account? $ <br /> <br />A Safety Deposit Box? $ <br /> <br />Money Hcld in Trust? $ <br /> <br />Any Stocks, Bonds or Sccurities? $ <br /> <br />Any Treasury Bills? $ <br /> <br />A Retirement Fund? (Includes IRA's, Keogh accounts) $ <br /> <br />Annuitics? $ <br /> <br />A Pension Fund? $ <br /> <br />Have any Personal Property hcld as an Investment (this includes: paintings, artwork, <br />collectors or show cars, jewelry, coin or stamp collections, antiques etc.)? $ <br /> <br />Other equity in real estate, rental property, land contracts/contract for deeds or other real <br />estatc holding or other capital investments (this includes your pcrsonal residence, mobile <br />homes, vacant land, farms, vacation homes, or commercial property)? Market Value Less: <br />(a) any unpaid balancc on loans secured by property, and (b) reasonable costs that would <br />bc incurred in selling the asset - penalties, broker fees, etc. $ <br /> <br />Received any Lump Sum Receipts? When $ <br />(Include inheritances, capital gains, lottery winnings, insurance settlements and other claims) <br /> <br />Other Assets not listed? $ <br /> <br />Have you disposed of any assets (e.g. real estate, cash, stock, etc.) in the past two years? <br />If yes, please describe: $ <br /> <br />5. EMPLOYMENT HISTORY: <br /> <br /> <br />Su ervisor: <br /> <br />Hours er week: <br /> <br />Overtime wa e: $ <br /> <br />Overtime hours er week: <br /> <br />Em 10 er Address: <br /> <br /> <br /> <br />How Lon : ervisor: <br />Current Wa e:$ Hours Overtime wa e: $ Overtime hours er week: <br />Em 10 er Address: <br />Other A <br /> Su ervisor: <br /> Hours er week: Overtime wa e: $ Overtime hours er week: <br />Em 10 er Address: <br /> <br />