
                             [FINANCIAL PROFILE]

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CHECKING  ACCOUNTS,  SAVINGS  ACCOUNTS,  CREDIT  UNION  ACCOUNTS, OTHER 
CASH
ACCOUNTS

Institution   Type # of Acct.  Int.  Current Bal.  Owned By    Location of
                               Rate                             Passbooks

____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________


MONEY MARKET FUNDS, CERTIFICATES OF DEPOSIT, TREASURY BILLS AND NOTES

Institution   Type # of Acct.  Int.  Current Bal.  Owned By    Location of
                               Rate                             Passbooks

____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________
____________  _______________  ____  ____________  __________  ____________


SECURITIES

Stocks and Mutual Funds:

 # of    Company    Purchase   Cost  Current  Owned   Location of   Annual 
Shares                Date            Value    By     Stock Cert.   Income

______  __________  _________  _____  ______  ______  ___________  _______
______  __________  _________  _____  ______  ______  ___________  _______
______  __________  _________  _____  ______  ______  ___________  _______
______  __________  _________  _____  ______  ______  ___________  _______


Bonds:  Corporate and Municipal

 Face    Company   Purch.  Matur.  Total   Int   Current   Owned   Locat.
Amount              Date    Date    Cost   Rate   Value     By     of book 
 
______  _________  ______  ______  ______  ____  _______  _______  _______
______  _________  ______  ______  ______  ____  _______  _______  _______
______  _________  ______  ______  ______  ____  _______  _______  _______
______  _________  ______  ______  ______  ____  _______  _______  _______
______  _________  ______  ______  ______  ____  _______  _______  _______
______  _________  ______  ______  ______  ____  _______  _______  _______


REAL ESTATE (RESIDENCE, RECREATIONAL, INCOME PROPERTY)

       Location            Purchase        Cost              Current
                             Date                         Market Value
_______________________   __________   _____________   __________________
_______________________   __________   _____________   __________________
_______________________   __________   _____________   __________________
_______________________   __________   _____________   __________________

