Disclosure Statement Page 6
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8(Rev. 6/07/06) CCDR 0604 F
Case No.____________________________
INVESTMENT ACCOUNTS and SECURITIES:
1.
Stocks
2.
Bonds
3.
Tax exempt securities
4.
Secured or Unsecured Notes
5.
Other (specify):
REAL PROPERTY:
(Provide address, type and description, amounts of mortgages, loans or liens)
1.
Residence
2.
Secondary or vacation residence
3.
Investment or Business Real Estate
4.
Vacant Land
5.
Other (specify):
MOTOR VEHICLE(s): Boats, Trailers, Etc. (Provide Year, Model, Make, Lien, Debtor, Amount)
BUSINESS INTERESTS: Corporations, Partnerships, Sole Proprietorships (Provide percentage interest and number of
shares, name of business, type of business, type of entity, current accounts receivable, current bank account balances,
current inventory value)
INSURANCE POLICIES: Life, medical, disability, business overhead, property, etc. (Provide type of insurance, insurer,
policy number, name of insured, owner of policy, face amount, beneficiary, face value, cash value, surrender value, current
death benefits)
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