Disclosure Statement Page 7
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8(Rev. 6/07/06) CCDR 0604 G
Case No. _____________________________
PENSION PLANS, IRA ACCOUNTS, DEFERRED COMPENSATION, ANNUITIES, 401K, etc.:
(Provide name and type of plan, trustee of plan, nature of interest, beneficiary, vested or non-vested, current value)
STOCK OPTIONS, ESOPS, OTHER DEFERRED COMPENSATION OR EMPLOYMENT BENEFITS:
(Describe fully)
INCOME TAX REFUNDS: Federal and State (Identify tax year)
CHOSES IN ACTION:
(Provide date of occurrence, nature/amount of claim, date suit filed, case number, name of plaintiffs)
COLLECTIBLES: (Coins, stamps, art, antiques, etc.)
ALL OTHER PROPERTY: (Personal or Real, NOT PREVIOUSLY LISTED valued in excess of $500.00)
STATEMENT OF ASSETS TRANSFERRED OR SOLD
List all assets transferred or sold in any manner during the preceding three years, or length of marriage, whichever is shorter
(transfers or sales in the routine course of business which resulted in an exchange of assets of substantially equivalent value
need not be specifically disclosed where such assets are otherwise identified in the statement of net worth.)
Description of Property
To Whom Transferred or Sold and
Date of Transfer
Value
Amount
Relationship to Transferee
Received
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