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{\*\generator Adobe Acrobat Exchange 9.4.1}{\info{\title O:\FORMS\Estate Planning Questionnaire.wpd}{\author cindy}{\creatim\yr2009\mo10\dy15\hr16\min44\sec52}{\revtim\yr2009\mo10\dy15\hr16\min45\sec50}{\id2550012}}\pard\plain\ql\f0\fs24\cf0 \paperh15840\paperw12240
\margt1375\margr209\margl491\pghsxn16340\pgwsxn12240\margtsxn1875\margrsxn209\marglsxn491\par\'20\pard\pard\s1\s2\sa241\qc\sl280\slmult0\b\fs23{\ul ESTATE PLANNING QUESTIONNAIRE }\b0\ulnone\strike0\ulnone\strike0\par\pard\s1\s2\sa277\qc\sl280\slmult0\fs23\f1 
In order for us to make a complete appraisal of your estate, including tax, personal and probate aspects, please complete this questionnaire as accurately as possible.  If a specific question does not apply, please note "N/A." \ulnone\strike0\par\pard\s1\qc\sl280\slmult0\fs23
{\ul I. }\ulnone\strike0\fs23{\ul FAMILY INFORMATION }\ulnone\strike0\ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 A. \fs23 Name: \ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 Birth Date: Social Security No.:                                                                Home Address: 
\ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Occupation: Business Address: \ulnone\strike0\par\pard\s4\s2\sa277\sl280\slmult0\fs23 Telephone: Home: Business:                                                                       Cell phone: E-mail Address:                                              Place of Birth: Citizenship: Date of Military Service, Rank and Serial Number: 
\ulnone\strike0\par\pard\s5\s6\sa552\qc\fs23 Comment on Health Problems, if any: \ulnone\strike0\par\pard\s7\fi-720\li720\sl280\slmult0\fs23 B\fs23 . \tab \fs23 Spouse's Name: Birth Date: Social Security No.:                                                              Occupation: Business Address: 
\ulnone\strike0\par\pard\s4\s2\sa277\sl280\slmult0\fs23 Telephone: Business\fs23 : \fs23 Cell phone: E-mail Address\fs23 :                                              \fs23 Place of Birth: Citizenship\fs23 : \fs23 Date of Military Service, Rank and Serial Number
\fs23 : \ulnone\strike0\par\pard\s5\s6\sa552\qc\fs23 Comment on Health Problems, if any: \ulnone\strike0\par\pard\s7\fi-720\li720\sl280\slmult0\fs23 C\fs23 . \tab \fs23 Children: Children and deceased children who have issue now living. Indicate prior marriage (P) or stepchild       
\ulnone\strike0\par\pard\s2\sa277\li720\sl278\slmult0\fs23 (S)\fs23  of Husband (H) or Wife (W). \ulnone\strike0\par\pard\fi-720\li1440\sl278\slmult0\fs23 1\fs23 . \tab \fs23 Name: \ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 Birth Date: Social Security No.:                                                   Home Address: 
\ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Adopted? ____Yes ____No Stepchild? ____Yes ____No If "Yes," natural parent is: Place of Birth: \ulnone\strike0\par\pard\li1440\fs23 Education Goal: \ulnone\strike0\par\pard\li1440\sl280\slmult0\fs23 Spouse's Name: Date of Marriage: 
\fs23 Is your relationship good:\ulnone\strike0\par\pard\pagebb\fi180\fs23  -\fs23 with child __________________________________\ulnone\strike0\par\pard\s8\s9\sa835\fi180\sl280\slmult0\fs23  -\fs23  with child's spouse? __________________________ Amount of annual support provided by client and spouse: $ Are there health problems or special needs of the child? 
\ulnone\strike0\par\pard\s5\qc\fs23 2. \fs23 Name: \ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 Birth Date: Social Security No.: Home Address: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Adopted? ____Yes ____No Stepchild? ____Yes ____No If "Yes," natural parent is: Place of Birth: 
\ulnone\strike0\par\pard\s5\qc\fs23 Education Goal: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Spouse's Name\fs23 : \fs23 Date of Marriage\fs23 : \fs23 Is your relationship good\fs23 :\ulnone\strike0\par\pard\s8\fi180\sl280\slmult0\fs23  -\fs23  with child? __________________________________
\ulnone\strike0\par\pard\s8\s9\sa835\fi180\sl280\slmult0\fs23  -\fs23  with child's spouse? __________________________ Amount of annual support provided by client and spouse: $ Are there health problems or special needs of the child? \ulnone\strike0\par\pard\s5\qc\fs23 
3. \fs23 Name: \ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 Birth Date: Social Security No.: Home Address: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Adopted? ____Yes ____No Stepchild? ____Yes ____No If "Yes," natural parent is: Place of Birth: \ulnone\strike0\par\pard\s5\qc\fs23 
Education Goal: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Spouse's Name\fs23 : \fs23 Date of Marriage\fs23 : \fs23 Is your relationship good\fs23 :\ulnone\strike0\par\pard\s8\fi180\sl280\slmult0\fs23  -\fs23  with child? ___________________________________
\ulnone\strike0\par\pard\s8\s9\sa835\fi180\sl280\slmult0\fs23  -\fs23  with child's spouse? ____________________________ Amount of annual support provided by client and spouse: $ Are there health problems or special needs of the child? \ulnone\strike0\par\pard\s5\sa380\qc\fs23 
4. \fs23 Name: \ulnone\strike0\par\pard\qj\sl658\slmult0\fs23 Birth Date: Social Security No.: Page 2 \ulnone\strike0\par\pard\pagebb\fs23 Home Address: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Adopted? ____Yes ____No Stepchild? ____Yes ____No If "Yes," natural parent is: Place of Birth: 
\ulnone\strike0\par\pard\s5\qc\fs23 Education Goal: \ulnone\strike0\par\pard\s4\sl280\slmult0\fs23 Spouse's Name\fs23 : \fs23 Date of Marriage\fs23 : \fs23 Is your relationship good\fs23 :\ulnone\strike0\par\pard\s8\fi180\sl280\slmult0\fs23  -\fs23  with child? ___________________________________
\ulnone\strike0\par\pard\s8\s9\sa835\fi180\sl280\slmult0\fs23  -\fs23  with child's spouse? ____________________________ Amount of annual support provided by client and spouse: $ Are there health problems or special needs of the child? \ulnone\strike0\par\pard\s5\s10\sa1117\qc\fs23 
D. Grandchildren: \fs23 E. Comments on health problems or special needs of grandchildren, if any: \ulnone\strike0\par{\shp{\*\shpinst \shpleft1180\shptop5997\shpright10914\shpbottom14604\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4982\clshdrawnil\cellx3840\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4358\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
NAME OF \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4982\clshdrawnil\cellx3840\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4358\row}\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cf0\fs23\f1 
Their Parents \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Grandchildren \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Age \cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cf0\fs23\f1 
(a) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 (1) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
(2) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow4\irowband4\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
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(b) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 (1) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow6\irowband6\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow7\irowband7\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
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(4) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow9\irowband9\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow10\irowband10\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cf0\fs23\f1 
(c) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 (1) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow10\irowband10\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow11\irowband11\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
(2) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow11\irowband11\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow12\irowband12\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
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(4) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow13\irowband13\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow14\irowband14\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cf0\fs23\f1 
(d) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 (1) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow14\irowband14\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}\trowd\irow15\irowband15\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
(2) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow15\irowband15\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4297\clshdrawnil\cellx3828\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4346\row}
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Their Parents \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Grandchildren \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Age \cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth1162\clshdrawnil\cellx2261\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3137\clshdrawnil\cellx3829\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4347\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth1162\clshdrawnil\cellx2261\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3137\clshdrawnil\cellx3829\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4347\pard\plain\intbl\qr\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
(3) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth1162\clshdrawnil\cellx2261\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3137\clshdrawnil\cellx3829\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4347\row}\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth1162\clshdrawnil\cellx2261\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3137\clshdrawnil\cellx3829\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4347\pard\plain\intbl\qr\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
(4) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2915\clshdrawnil\cellx1349\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth662\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth1162\clshdrawnil\cellx2261\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrnil\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3137\clshdrawnil\cellx3829\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1037\clshdrawnil\cellx4347\row}
}}}\pard\plain\par\pard\s5\s11\sa660\qc\fs23 F. \fs23 Other Beneficiaries (including great-grandchildren): \ulnone\strike0\par{\shp{\*\shpinst \shpleft2034\shptop5868\shpright13545\shpbottom6246\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\qc\cf0\fs23\f1 
Name \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Relationship \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Amount or Type of Gift \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s2\sa277\fi-720\li720\sl560\slmult0\fs23 G\fs23 . \tab \fs23 Parents (state age, if living): Husband's:  Father ______ Mother ______ Wife's:  Father ______ Mother ______ \ulnone\strike0\par\pard\s12\sa1397\sl560\slmult0\fs23 H. \fs23 
Comment on support provided to parents, if any: \ulnone\strike0\par\pard\s3\s2\sa277\qj\sl280\slmult0\fs23 I. \fs23 Date and Place of Marriage: \ulnone\strike0\par\pard\s13\s9\sa835\fi-720\li720\qj\sl280\slmult0\fs23 J\fs23 . \tab While married to each other, have you lived in Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Puerto Rico, Texas, Wisconsin, Washington, or other community property jurisdictions? If so, please 
\fs23 list the state and period lived in the state, and property acquired while a resident of the state.  (Furnish details on back of this page if additional space is needed.) \ulnone\strike0\par\pard\pagebb\li7500\qj\sl278\slmult0\fs23{\ul Husband Wife }\ulnone\strike0\ulnone\strike0\par\pard\s13\fi-720\li720\qj\sl280\slmult0\fs23 
K\fs23 . \tab \fs23 Prior Marriage? If yes, do you have financial responsibilities? _______ ____ (Furnish details on back of this page) _______ ____ \ulnone\strike0\par\pard\s14\sa380\fi2500\ri817\qj\sl560\slmult0\fs23 II. \fs23{\ul FINANCIAL DATA (USE APPROXIMATE VALUES) Bank/Savings Accounts: 
}\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft2471\shptop4878\shpright13959\shpbottom5256\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4387\clshdrawnil\cellx2085\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2137\clshdrawnil\cellx3153\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2137\clshdrawnil\cellx4221\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5234\pard\plain\intbl\qc\cf0\fs23\f1 
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}}}\pard\plain\par\pard\s2\sa277\fi0\li6685\fs23 Total \fs23 $ \tab \fs23 $ $ \ulnone\strike0\par\pard\s15\s16\sa112\qj\fs23{\ul Bonds: }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop8041\shpright12096\shpbottom9303\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw30\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3307\clshdrawnil\cellx1545\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw30\brdrcf0\clbrdrr\brdrth\brdrw35\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2487\clshdrawnil\cellx2788\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw35\brdrcf0\clbrdrr\brdrth\brdrw30\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2385\clshdrawnil\cellx3980\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw30\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2477\clshdrawnil\cellx5218\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
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}}}\pard\plain\par\pard\s16\sa112\ri0\sl560\slmult0\fs23  Total $_________ $____________ $_________ \fs23{\ul Notes, Mortgages & Accounts Receivable}\ulnone\strike0\fs23   Indicate if owned by Husband (H) or Wife (W)                                                         
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}}}\pard\plain\par\pard\s2\sa277\li2760\qj\sl278\slmult0\fs23  Total $________ $________ \ulnone\strike0\par\pard\s14\sa380\fi-1440\li1440\qj\sl278\slmult0\fs23{\ul Real Estate\fs23 : \tab }\ulnone\strike0\fs23 (List all real property including condominiums and co-ops.  List farmland in Section III, page 11.) 
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Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
1. Cars/Motor Vehicles \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
2. Personal Effects, Jewelry \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
3. Collections, Art, Etc. \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow4\irowband4\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
4. Household Effects \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow5\irowband5\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
5. Other: (Describe)\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow6\irowband6\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow6\irowband6\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}\trowd\irow7\irowband7\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow7\irowband7\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4027\clshdrawnil\cellx1905\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx3153\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil\cellx4268\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\cellx5236\row}
}}}\pard\plain\par\pard\s17\s2\sa277\li2920\fs23  Total $________ $________ $________ \ulnone\strike0\par\pard\s15\s14\sa380\qj\fs23{\ul Employee Benefits: }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop6794\shpright12151\shpbottom10250\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 
Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw40\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow1\irowband1\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
1. Qualified Employer Pension or Profit Sharing \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw40\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
2. IRA's \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
3. Post-Death Salary Continuation \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow4\irowband4\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
4. Stock Options \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow5\irowband5\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
5. Other: (Describe) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow6\irowband6\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow6\irowband6\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow7\irowband7\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow7\irowband7\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}\trowd\irow8\irowband8\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow8\irowband8\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3037\clshdrawnil\cellx3783\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2927\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s5\qc\fs23 Total $_____________ $______________ \ulnone\strike0\par\pard\s14\pagebb\sa380\fs23{\ul Oil and Gas Interests: }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop1739\shpright12128\shpbottom2117\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4837\clshdrawnil\cellx2310\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx3333\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1957\clshdrawnil\cellx4311\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1847\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Description \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell 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{\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell 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{\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell 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}}}\pard\plain\par\pard\s18\s14\sa380\qj\sl560\slmult0\fs23 Total $_____________ $____________ $____________ \fs23{\ul Business Interests:}\ulnone\strike0\fs23   (Complete itemized schedule attached to questionnaire) \ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop4966\shpright12151\shpbottom6440\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Description \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Schedule # \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow2\irowband2\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Schedule #\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s18\s14\sa380\qj\sl560\slmult0\fs23  Total $____________________ $______________________ \fs23{\ul Life Insurance:}\ulnone\strike0\fs23   (Complete itemized schedule attached to questionnaire) \ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop7735\shpright12151\shpbottom9209\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Description \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Schedule # \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow2\irowband2\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Schedule #\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s2\sa277\li2460\fs23  Total $___________________ $__________________ \ulnone\strike0\par\pard\s15\s14\sa380\qj\fs23{\ul Other Assets: }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop10505\shpright12128\shpbottom13626\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Description \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
1. Taxable Interests in self-created trusts \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
2. Powers of Appointment \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
3. Expectancies (Describe) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow4\irowband4\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
4. Investment Club Interest \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow5\irowband5\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
5. Copyrights, Trademarks, Patents, Franchises \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}
}}}\pard\plain\par{\shp{\*\shpinst \shpleft640\shptop1243\shpright12128\shpbottom4699\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Description \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
6. Foreign Assets \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow2\irowband2\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
7. Taxable Beneficial Interests in estates and trusts created by others \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
8. Incentive Stock Options \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow4\irowband4\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
9. Stock Appreciation Rights \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow5\irowband5\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
10. Other: (Describe) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow6\irowband6\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow6\irowband6\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}\trowd\irow7\irowband7\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow7\irowband7\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth5467\clshdrawnil\cellx2625\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx3513\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4401\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1667\clshdrawnil\cellx5234\row}
}}}\pard\plain\par\pard\s6\sa552\li4320\fs23 Total $ _________ $ _________ $ _________ \ulnone\strike0\par\pard\s15\s14\sa380\qj\fs23{\ul Liabilities:}\ulnone\strike0\fs23  (not previously listed) \ulnone\strike0\par{\shp{\*\shpinst \shpleft1693\shptop6858\shpright13161\shpbottom7570\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3127\clshdrawnil\cellx1455\clvertalb\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx2793\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1150\clshdrawnil\cellx3368\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1957\clshdrawnil\cellx4346\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1757\clshdrawnil\cellx5224\pard\plain\intbl\qc\cf0\fs23\f1 
Creditor \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Secured By \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Due Date \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Repayment Schedule \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
Current Balance \cell 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{\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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}}}\pard\plain\par\pard\s2\sa277\fi8640\sl280\slmult0\fs23 Total $_________ Is your spouse or are you the guarantor on any debt, either business or personal? __________. If so, please attach a copy of all promissory notes and other documentation relating to the guarantee. 
\ulnone\strike0\par\pard\s1\qc\sl280\slmult0\fs23 III. \fs23{\ul ADVISERS }\ulnone\strike0\ulnone\strike0\par\pard\s4\s2\sa277\sl280\slmult0\fs23 A. \fs23 Names and Addresses of Advisers: \ulnone\strike0\par\pard \ls1\ilvl0\fi-360\li360\sa493\fs23 Stockbrokers: 
\par\fi-360\li360\fs23 Life Insurance Adviser: \par\fi-360\li360\fs23 General Insurance Adviser: \par\fi-360\li360\fs23 Banker and Trust Officer: \par\fi-360\li360\fs23 Investment Adviser: \par\fi-360\li360\fs23 Other Attorney: \par\fi-360\li360\sa0\fs23 
Accountant: \par\pard\par\pard\s1\s2\pagebb\sa277\qc\sl280\slmult0\fs23 IV. \fs23{\ul FARM BUSINESS INFORMATION (IF APPLICABLE) }\ulnone\strike0\ulnone\strike0\par\pard\s3\qj\sl280\slmult0\fs23 I farm ________ acres, of which ________ acres are owned and ________acres are farmed on land owned by ______________________________________________________. My three major income-producing crops are: 
\ulnone\strike0\par\pard\s4\s6\sa552\sl280\slmult0\fs23 My farm business is operated as a\fs23 : \fs23 _______ Sole proprietorship _______ Partnershi\fs23 p \fs23 _______ Regular Corporation _______ Subchapter S Corporatio\fs23 n \fs23 _______ Other (please specify
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}}}\pard\plain\par\pard\s5\qc\fs23  Total $________ $________ $________ $________ \ulnone\strike0\par\pard\s14\pagebb\sa380\fs23{\ul Personal Property}\ulnone\strike0\fs23 : \ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop2018\shpright12085\shpbottom9527\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2227\clshdrawnil\cellx1005\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3032\clshdrawnil\cellx2521\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1422\clshdrawnil\cellx3232\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3940\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1330\clshdrawnil\cellx4605\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1217\clshdrawnil\cellx5213\pard\plain\intbl\ql\cf0\fs23\f1 
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}}}\pard\plain\par\pard\s2\sa277\li3600\fs23 Total $_______ $_________ $_______ $_______ \ulnone\strike0\par\pard\s15\s14\sa380\qj\fs23{\ul Liabilities: }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft1693\shptop10795\shpright13161\shpbottom11507\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3127\clshdrawnil\cellx1455\clvertalb\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx2793\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1150\clshdrawnil\cellx3368\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1957\clshdrawnil\cellx4346\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1757\clshdrawnil\cellx5224\pard\plain\intbl\qc\cf0\fs23\f1 
Creditor \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Secured By \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Due Date \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Repayment Schedule \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 
Current Balance\cell 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{\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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}}}\pard\plain\par\pard\s17\li2920\fs23  Total $_________ \ulnone\strike0\par\pard\pagebb\li2105\sl560\slmult0\fs23 V. \fs23{\ul CLOSELY HELD BUSINESS INTERESTS (IF APPLICABLE) }\ulnone\strike0\ulnone\strike0\par\pard\s2\sa277\fi3190\sl560\slmult0\fs23 (Use separate sheet for each business interest) Name Percent Owned: 
\ulnone\strike0\par\pard\s2\sa277\fs23 Address \ulnone\strike0\par\pard\s4\s16\sa112\sl280\slmult0\fs23 Type of Entity\fs23 :\fs23  Regular Corporation ______ Subchapter S Corporation _____\fs23 _\ulnone\strike0\par{\shp{\*\shpinst \shpleft520\shptop3919\shpright10106\shpbottom4967\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh135\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\pard\plain\intbl\ql\cf0\fs23\f1 
 Partnership \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 ______ Sole Proprietorship \cell {\pard\plain\intbl}\pard\plain\intbl\cf0\fs23\f1 ______\cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh135\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\row}\trowd\irow1\irowband1\trgaph108\trrh138\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\pard\plain\intbl\ql\cf0\fs23\f1 
     Limited Liability\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh138\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\row}\trowd\irow2\irowband2\lastrow\trgaph108\trrh135\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\pard\plain\intbl\ql\cf0\fs23\f1 
     Company\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1  ______ \cell {\pard\plain\intbl}\pard\plain\intbl\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\lastrow\trgaph108\trrh135\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth2147\clshdrawnil\cellx965\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3362\clshdrawnil\cellx2646\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth3277\clshdrawnil\cellx4284\row}
}}}\pard\plain\par\pard\s5\s6\sa552\qc\fs23 Is interest jointly owned with spouse or relative? If so, list each person and interest owned. \ulnone\strike0\par\pard\s12\sl560\slmult0\fs23 Estimated fair market value of your interest Method of arriving at value Annual income of business 
\ulnone\strike0\par\pard\s12\s9\sa835\sl560\slmult0\fs23 Prospects of growt\fs23 h \fs23 Do you have any plans to dispose of business interest during your lifetime? If so, please describe\fs23 . \ulnone\strike0\par\pard\s5\s2\sa277\qc\fs23 What are your wishes as to disposition of ownership after death? 
\ulnone\strike0\par\pard \ls2\ilvl0\fi-360\li360\sa213\fs23 Transfer to family \par\fi-360\li360\fs23 Sale to co-owner of business \par\fi-360\li360\fs23 Sale to key employee \par\fi-360\li360\sa0\fs23 Other \par\pard\par\pard\s12\sa197\sl560\slmult0\fs23 
Is there a buy/sell or redemption agreement? Yes ______ No _____\fs23 _ \fs23 Please provide financial statements and tax returns for the previous two years\fs23 . \ulnone\strike0\par\pard\li4957\sl560\slmult0\fs23 Page 12 \ulnone\strike0\par\pard\s5\s14\pagebb\sa380\qc\fs23 
VI. \fs23{\ul RECAP OF ASSETS & LIABILITIE\fs23 S }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop1803\shpright12131\shpbottom10197\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Assets \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Bank/Savings Accounts \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Bonds (Face Value @ Maturity) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Stocks and Mutual Fund Shares \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow4\irowband4\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Notes, Mortgages & Accounts Receivable (face value) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh357\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow5\irowband5\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Real Estate \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow6\irowband6\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Tangible Property \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow6\irowband6\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow7\irowband7\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Employee Benefits \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow7\irowband7\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow8\irowband8\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Oil and Gas Interests \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow8\irowband8\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow9\irowband9\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Business Interest \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow9\irowband9\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow10\irowband10\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Life Insurance \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow10\irowband10\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow11\irowband11\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Other Assets \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow11\irowband11\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow12\irowband12\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
Farm Business Information:\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow12\irowband12\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow13\irowband13\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
 Real Estate\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow13\irowband13\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}\trowd\irow14\irowband14\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\pard\plain\intbl\ql\cf0\fs23\f1 
 Personal Property\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow14\irowband14\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4207\clshdrawnil\cellx1995\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil\cellx3200\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2047\clshdrawnil\cellx4223\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2027\clshdrawnil\cellx5236\row}
}}}\pard\plain\par\pard\s5\s14\sa380\qc\fs23  TOTAL ASSETS $__________ $__________ $_________\fs23 _ \ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop9779\shpright12128\shpbottom11802\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Liabilities \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Husband \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Wife \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs23\f1 Joint \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\row}\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Real Estate \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\row}\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Other Liabilities (page 9) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\row}\trowd\irow3\irowband3\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\pard\plain\intbl\ql\cf0\fs23\f1 
Farm Business Information\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2857\clshdrawnil\cellx1320\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2497\clshdrawnil\cellx2568\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2677\clshdrawnil\cellx3906\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2657\clshdrawnil\cellx5234\row}
}}}\pard\plain\par\pard\s18\qj\sl560\slmult0\fs23  TOTAL LIABILITIES $__________ $__________ $__________ NET TOTAL $__________ $__________ $__________ \ulnone\strike0\par\pard\s5\s2\pagebb\sa277\qc\fs23 VII. \fs23{\ul DOCUMENTS TO BE ATTACHE\fs23 D }\ulnone\strike0\ulnone\strike0\par\pard\s5\qc\fs23 
Unless otherwise noted, please attach a copy of the following documents to this questionnaire.  If they do not \ulnone\strike0\par\pard\s2\sa277\fi-6420\li6420\sl280\slmult0\fs23 apply to you, please mark "N/A."\fs23{\ul  Attached or N/A }\ulnone\strike0\ulnone\strike0\par\pard \fs23 
1\fs23 . \li0\sa213\fs23 Existing Wills of both spouses ______________ \par\fs23 2\fs23 . \li0\fs23 Gifts tax returns filed by either spouse ______________ \par\fs23 3\fs23 . \li0\fs23 Life insurance policies, or an analysis of each policy prepared by your insurance agent 
\par\fs23 4\fs23 . \li0\fs23 Buy/sell or redemption agreements                       ______________ \par\fs23 5\fs23 . \li0\fs23 Trust instruments under which either spouse is a beneficiary or trustee ______________ \par\fs23 6\fs23 . \li0\fs23 Trust instruments created by either spouse               ______________ 
\par\fs23 7\fs23 . \li0\fs23 Personal income tax return for prior year                ______________ \par\fs23 8\fs23 . \li0\fs23 Business financial statements for past five years        ______________ \par\fs23 9\fs23 . \li0\fs23 Business agreements and documents regarding interests in corporations, partnerships and sole proprietorships ______________ 
\par\fs23 10\fs23 . \li0\fs23 Pre- or post-nuptial agreements                           ______________ \par\fs23 11\fs23 . \li0\fs23 Instruments creating spouses' joint tenancies or tenancies by the entireties ______________ \par\fs23 12\fs23 . \li0\fs23 
Copy of deeds to real property ______________ \par\fs23 13\fs23 . \li0\fs23 Copy of stock certificates and bonds, or latest broker statement if held in street account               ______________ \par\fs23 14\fs23 . \li0\fs23 Power of appointments ______________ 
\par\fs23 15\fs23 . \li0\fs23 Decree of Divorce (if prior marriage)                    ______________ \par\fs23 16\fs23 . \li0\sa0\fs23 All promissory notes and other documentation in which your spouse or you have guaranteed any debt ______________ \par\pard\par\pard\s2\pagebb\sa277\li3527\qj\sl278\slmult0\fs23 
VIII. \fs23{\ul DISTRIBUTION OBJECTIVES }\ulnone\strike0\ulnone\strike0\par\pard\s3\s14\sa380\qj\sl280\slmult0\fs23 A. \fs23 Are there any members of your family, relatives, friends or charities to whom you would like to leave specific gifts? \ulnone\strike0
\par{\shp{\*\shpinst \shpleft640\shptop2578\shpright12154\shpbottom2956\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh223\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\pard\plain\intbl\ql\cf0\fs23\f1 
Name & Address \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Relationship \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Item or Amount \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh223\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\row}\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\row}\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\row}\trowd\irow4\irowband4\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth4747\clshdrawnil\cellx2265\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth2590\clshdrawnil\cellx3560\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3377\clshdrawnil\cellx5248\row}
}}}\pard\plain\par\pard\s2\sa277\fs23 B. \fs23 Upon your death, how and to whom do you want your assets distributed, if: \ulnone\strike0\par\pard \fs23 (1) \li0\sa773\fs23 Your spouse survives you: \par\fs23 (2) \li0\sa0\fs23 Your spouse does not survive you: 
\par\pard\par\pard\s3\s2\sa277\qj\sl280\slmult0\fs23 C. \fs23 In the event of death: \ulnone\strike0\par\pard\s19\sa997\fi-720\li1440\qj\sl278\slmult0\fs23 (1\fs23 ) \fs23 If your spouse and you both die prematurely, should children receive property at age of majority (age 18) or should it be held to a more mature age? 
\ulnone\strike0\par{\shp{\*\shpinst \shpleft1240\shptop9851\shpright10528\shpbottom13584\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh276\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\pard\plain\intbl\ql\cf0\fs23\f1 
(2) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Is your spouse a good money manager? \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh276\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\row}\trowd\irow1\irowband1\trgaph108\trrh490\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\pard\plain\intbl\ql\cf0\fs23\f1 
(3) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Do you want your spouse to manage your estate from an investment standpoint? \cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh490\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\row}\trowd\irow2\irowband2\trgaph108\trrh488\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\pard\plain\intbl\ql\cf0\fs23\f1 
(4) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 To whom would your spouse look for management help? \cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh488\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\row}\trowd\irow3\irowband3\lastrow\trgaph108\trrh272\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\pard\plain\intbl\ql\cf0\fs23\f1 
(5) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Is avoiding unnecessary estate taxation of great importance to you? \cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh272\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth505\clshdrawnil\cellx144\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil\cellx4106\row}
}}}\pard\plain\par{\shp{\*\shpinst \shpleft1240\shptop1123\shpright12016\shpbottom10559\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh397\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(6) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Do you contemplate making future gifts? Furnish details: \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh397\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}\trowd\irow1\irowband1\trgaph108\trrh700\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(7) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Do you wish to make bequests to your church or synagogue or to any other charitable organization? Furnish Details: \cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh700\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}\trowd\irow2\irowband2\trgaph108\trrh855\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(8) (9) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 If none of your children are living at the time of your spouse's death, do you want your estate to go to: Your family? _____ Spouse's family? ________ Elsewhere? Does your spouse have employment skills? Do you expect the survivor will work? 
\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh855\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}\trowd\irow3\irowband3\trgaph108\trrh768\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(10) (11) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Will your spouse live in your present home? To what extent has your spouse or you utilized your unified credit exemption? \cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh768\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}\trowd\irow4\irowband4\trgaph108\trrh490\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(12) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Has your spouse or you ever filed a gift tax return? If so, provide a copy. \cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh490\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalc\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}\trowd\irow5\irowband5\lastrow\trgaph108\trrh691\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\pard\plain\intbl\ql\cf0\fs23\f1 
(13) (14) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Are you willing to make gifts to your spouse or other beneficiaries now if it will accomplish an estate tax savings? Is your spouse or are you a grantor of a Trust?  If so, provide a copy of the agreement. 
\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\lastrow\trgaph108\trrh691\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil\cellx174\clvertalb\clbrdrt\brdrnil\clbrdrb\brdrnil\clbrdrl\brdrnil\clbrdrr\brdrnil\cltxlrtb\clftsWidth3\clwWidth9352\clshdrawnil\cellx4850\row}
}}}\pard\plain\par\pard\s5\s2\sa277\qc\fs23 IX. \fs23{\ul EXECUTORS/TRUSTEES/GUARDIANS/POWER OF ATTORNEY }\ulnone\strike0\ulnone\strike0\par\pard\s15\s2\sa277\qj\fs23 A. \fs23 Executor: \ulnone\strike0\par\pard\s20\s14\sa380\li720\qj\sl280\slmult0\fs23 If it should be necessary to probate all or any part of your estate, who should be your executor and their successor? 
\ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop11868\shpright12151\shpbottom12246\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Name \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Relationship \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Address \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh218\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}\trowd\irow2\irowband2\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\lastrow\trgaph108\trrh207\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s12\s9\pagebb\sa835\sl560\slmult0\fs23 B. \fs23 Corporate Executor\fs23 : \fs23 If the individual executors were unable to serve, what bank would you prefer as executor\fs23 ? \ulnone\strike0\par\pard\s3\s2\sa277\qj\sl280\slmult0\fs23 
C. \fs23 Individual Trustees: \ulnone\strike0\par\pard\s20\s11\sa660\li720\qj\sl280\slmult0\fs23 If your Will established a testamentary trust, who should be your trustee? List at least two. (Your spouse may act as trustee in certain circumstances.) \ulnone\strike0
\par{\shp{\*\shpinst \shpleft640\shptop4599\shpright12151\shpbottom4977\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Name \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Relationship \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Address \cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s12\s9\sa835\sl560\slmult0\fs23 D. \fs23 Corporate Trustee\fs23 : \fs23 If the individual trustees were unable to serve, what bank or trust company would you prefer as trustee\fs23 ? \ulnone\strike0\par\pard\s3\s2\sa277\qj\sl280\slmult0\fs23 
E. \fs23 Guardians: \ulnone\strike0\par\pard\s20\s14\sa380\li720\qj\sl280\slmult0\fs23 If your spouse and you should both be deceased, who do you wish to serve as guardian and conservator of your minor children? \ulnone\strike0\par{\shp{\*\shpinst \shpleft640\shptop9783\shpright12151\shpbottom10161\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh217\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\pard\plain\intbl\ql\cf0\fs23\f1 
Name \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Relationship \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs23\f1 Address \cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell 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{\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\lastrow\trgaph108\trrh208\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx1680\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3577\clshdrawnil\cellx3468\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil\cellx5246\row}
}}}\pard\plain\par\pard\s12\sl560\slmult0\fs23 F. \fs23 Bond\fs23 : \fs23 If you want the Executor, Trustee, Guardian or their successors to furnish bond, specify\fs23 : \ulnone\strike0\par\pard\s15\s2\pagebb\sa277\qj\fs23 G. \fs23 Do you have a Durable Power of Attorney? 
\ulnone\strike0\par\pard\s15\s2\sa277\qj\fs23 H. \fs23 Do you have a Durable Power of Attorney for Health Care Decisions? \ulnone\strike0\par\pard\fs23 I. \fs23 Would you like to discuss a Living Will or "right to die" statement? _____________________________ 
\ulnone\strike0\par\pard\s5\s14\pard\plain\sect\sectd\pghsxn16340\pgwsxn12240\marglsxn491\margrsxn209\margtsxn1875\margbsxn1470\sbknone\cols3\colno1\colw315\colsr331\colno2\colw1452\colsr331\colno3\colw315\colsr331\colsr0\linex0\sectdefault\pagebb\sa380\qc\fs23
{\ul LIFE INSURANCE ON YOU AND YOUR SPOUS\fs23 E }\ulnone\strike0\ulnone\strike0\par{\shp{\*\shpinst \shpleft1140\shptop1817\shpright16091\shpbottom4695\shpfhdr0\shpbxpage\shpbypage\shpwr5\shpwrk0\shpfblwtxt1{\sp{\sn shapeType}{\sv 202}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\shptxt\trowd\irow0\irowband0\trgaph108\trrh290\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
No. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 Company Name \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 Insured \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 Face Amount \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 
Policy Loans \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 Type of Policy (whole, life, term, etc.) \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs18\f1 Owner \cell {\pard\plain\intbl}\pard\plain\intbl\qc\cf0\fs18\f1 Value \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 
Beneficiary (Primary or Second) \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cf0\fs18\f1 Annual Premium \cell {\pard\plain\intbl}{\trowd\irow0\irowband0\trgaph108\trrh290\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}\trowd\irow1\irowband1\trgaph108\trrh183\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
1. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow1\irowband1\trgaph108\trrh183\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}\trowd\irow2\irowband2\trgaph108\trrh185\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
2. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow2\irowband2\trgaph108\trrh185\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}\trowd\irow3\irowband3\trgaph108\trrh183\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
3. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow3\irowband3\trgaph108\trrh183\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}\trowd\irow4\irowband4\trgaph108\trrh185\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
4. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow4\irowband4\trgaph108\trrh185\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}\trowd\irow5\irowband5\lastrow\trgaph108\trrh210\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\pard\plain\intbl\ql\cf0\fs18\f1 
5. \cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\qc\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}\pard\plain\intbl\ql\cell {\pard\plain\intbl}{\trowd\irow5\irowband5\lastrow\trgaph108\trrh210\trleft-108\trbrdrt\brdrnil\trbrdrb\brdrnil\trbrdrl\brdrnil\trbrdrr\brdrnil\clvertalc\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth697\clshdrawnil\cellx240\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx1216\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1057\clshdrawnil\cellx1744\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1325\clshdrawnil\cellx2406\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\cellx3114\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1952\clshdrawnil\cellx4090\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx4978\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth965\clshdrawnil\cellx5460\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1777\clshdrawnil\cellx6348\clvertalt\clbrdrt\brdrth\brdrw22\brdrcf0\clbrdrb\brdrth\brdrw22\brdrcf0\clbrdrl\brdrth\brdrw22\brdrcf0\clbrdrr\brdrth\brdrw22\brdrcf0\cltxlrtb\clftsWidth3\clwWidth1232\clshdrawnil\cellx6964\row}
}}}\pard\plain\par\pard \ls5\ilvl0\fi-360\li360\fs23 Does any corporation or partnership in which you or your spouse have an interest own insurance on either of your lives? \par\fi-360\li360\fs23 Do you or your spouse own insurance on any other person? If so, please list above. 
\par\fi-360\li360\sa0\fs23 Do you have any plans to increase or decrease insurance coverage? ____________  If so, please explain. \par\pard\par\pard\s5\qc\fs23 Page 19 \ulnone\strike0 }