Form A - Financial Disclosure Statement - 2016 Page 8
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12SCHEDULE D – LIABILITIES
Name:
Page______ of _______
Report liabilities of over $10,000 owed to any one creditor at any time during the reporting period by you, your spouse, or your dependent child. Mark the highest amount owed during the reporting
period. Members: Members are required to report all liabilities secured by real property including mortgages on their personal residence. Exclude: Any mortgage on your personal residence (unless
you rent it out or are a Member); loans secured by automobiles, household furniture, or appliances; liabilities of a business in which you own an interest (unless you are personally liable); and liabilities
owed to you by a spouse or the child, parent, or sibling of you or your spouse. Report a revolving charge account (i.e., credit card) only if the balance at the close of the reporting period exceeded
$10,000.
*Column K is for liabilities held solely by your spouse or dependent child.
Amount of Liability
A
B
C
D
E
F
G
H
I
J
K
Date
Liability
SP,
Creditor
Type of Liability
Incurred
DC, JT
MO/YR
X
Example
First Bank of Wilmington, DE
5/98
Mortgage on Rental Property, Dover, DE
SCHEDULE E – POSITIONS
Report all positions, compensated or uncompensated, held during the current or prior calendar year as an officer, director, trustee of an organization, partner, proprietor, representative, employee, or
consultant of any corporation, firm, partnership, or other business enterprise, nonprofit organization, labor organization, or educational or other institution other than the United States. Exclude:
Positions held in any religious, social, fraternal, or political entities (such as political parties and campaign organizations); and positions solely of an honorary nature.
Position
Name of Organization
Use additional sheets if more space is required.
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Parent category: Legal