| CATEGORY |
CURRENT VALUE |
| ASSETS: |   |
| Cash in Savings Accounts |   |
| Cash in Checking Accounts |   |
| Certificates of Deposit (CDs) |   |
| Cash on Hand |   |
| Money Market Accounts |   |
| Money Owed to Me (Rent Deposits, etc.) |   |
| Cash Value of Life Insurance |   |
| Savings Bonds (current value) |   |
| Stocks |   |
| Bonds |   |
| Mutual Funds |   |
| Vested Value of Stock Options |   |
| Other Investments |   |
| Individual Retirement Accounts (IRAs) |   |
| Keogh Accounts |   |
| 401(k) or 403(b) Accounts |   |
| Other Retirement Plans |   |
| Market Value of Your Home |   |
| Market Value of Other Real Estate |   |
| Blue Book Value of Cars/Trucks |   |
| Boats, Planes, Other Vehicles |   |
| Jewelry |   |
| Collectibles |   |
| Furnishings and Other Personal Property |   |
| Other |   |
| TOTAL ASSETS |   |
|   |   |
| LIABILITIES: |   |
| Mortgages |   | |
| Car Loans |   |
| Bank Loans |   |
| Student Loans |   |
| Home Equity Loans |   |
| Other Loans |   |
| Credit Card Balances |   |
| Real Estate Taxes Owed |   |
| Income Taxes Owed |   |
| Other Taxes Owed |   |
| Other Debts |   |
| TOTAL LIABILITIES |   |
|   |   |
| NET WORTH (TOTAL ASSETS LESS TOTAL LIABILITIES) |   |