DESCRIPTION                     MARKET VALUE    LOANS      EQUITY
 HOUSE
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 OTHER REAL ESTATE
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 BANK ACCOUNTS
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 VEHICLES/BOATS/CYCLES/MOTORHOME
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 STOCK
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 RETIREMENT
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 INSURANCE
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 BUSINESS/PARTNERSHIP/CORPORATION
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
 FURNITURE/JEWELRY/ART/TOOLS/COLLECTABLES/OTHER MISCELLANEOUS
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 ___________________________________  $________     $________  $________
 
           NAME/BUSINESS NAME       PHONE             ADDRESS
 
 ATTORNEY  _____________________  ________________  ____________________
 
 INS. AGENT ____________________  ________________  ____________________
 
 TAX ADVISOR ___________________  ________________  ____________________