3.
Yes
No
County
Parcel No., Tract and Lot, or other Description from Deed, Contract, or Tax Bill
4.
Yes
No
County
5.
Yes
No
6.
Yes
No
Total non-assessable business assets (except vehicles which should be entered in question 10) such as inventory, cash on hand, checking
and savings accounts, accounts receivable, stocks, bonds, liquor license:
$
times my and/or my spouse’s ownership interest
% = $
(Note: if you own livestock or a racehorse, see instructions for question 6.)
7. My household furnishings and personal effects are located at
8. Report all cash in possession, in safe deposit boxes, and in personal checking and savings accounts in banks, savings and loan, building and loan, postal savings, credit unions, etc. (Note: Do not include that reported in Item 6 above.)
9.
Yes
No
10.
Yes
No
11.
Yes
No
12.
Yes
No
13.
Yes
No
