|
<br />...,. .-----=...l;LQ;:..~nfL___
<br />
<br />To'
<br />
<br />.a/'l~
<br />
<br />a'~\l_.. ~i70li{.l:Qr:dlL_2.::L_______
<br />
<br />(11y
<br />
<br />51"'.
<br />
<br />. phCr'le._ ~:L:_2.:-~;~_______
<br />
<br />.._>.~_. .._._ .m., ___~___
<br />....- -.,----~-------.-
<br />
<br />y.,O
<br />1'0100
<br />
<br />';".'1 0' O""~(Jt,o"._ -~,('_t.,5.l.:..C'i.L_._._______~____~.____.
<br />"I">H 0' omlo' ,n ol">r o!t,_, ."rHvr,,_ _~~:J!~1:_. ~.____
<br />
<br />d . will d"po\in~
<br />14.we yOU cX"ocute t gi---daa\h7
<br />cstai 0 In eVUll
<br />-----"I---'{Q.\!L---f<
<br />-1uo...M!"'e E.xocu ~r
<br />
<br />< W"'tO,'''hpl".J'l'd?
<br />
<br />--~;Q-----------
<br />
<br />.. )<:J" ,,'e, mOd." (O""'POlOl,O" uttlem""j or IQ.." bo"~rvpl("y? f.ploinc.-----1:In....
<br />
<br />f~, I~" P'''l'c'. (,I p'o<v,i"9 (lnd m"i"lo;"i"9 <.-edil {(err. I;m~ 10 lim. in OilY form ....flOflot!\lef wifll Ih, obo.... nonud Bonk. for daiml and d.l'IlondJ 'oQolnll 11'>0
<br />.J."';;n~..J. ,he 'If,uu,ig".d Ivb",;I, 1i'I. following "I being (] Ir". ond ouurol, "ol."n.nl 01 i'J "nontio1 {ol'ldil;ol'l on Ih. lollowing dol.., and ogr..' 1"01 it any chon",.
<br />,.." :I-.'~' ~"I'''oILr ,..d",", 1/", "'.0'" 0' obility of 1"" Ur'ld.",gnod to poy 011 clo;",. or demand I again I' iI, lhe und""ign"d.....iII lmm.diol.lr and .....ill'> 0.... d.lay noldy
<br />, ,,,:,, ~~"'. ,.,,,,, ".-.1.,. I)-,e Boni i. 10 nol;fl.d il ."oy (onl;nu.. 10 'ol)' upon Ihe IIOlemen! h",,,in p;V~1l fl' 0 Iru. ond oc(vrole IIOl.mll,,1 01 tn. ~nort<iol cOlldUion 0/
<br />..~-.._. 19_...81~. lnco",,, ho.... f;dimo"y, cl'>lld ,uPPor'! or mo,nl."on(c
<br />nor chc:>o.e 10 diu!,?I_ Il"n incom. in oP~I}'in9 for. "Idit.
<br />
<br />J.tme_10.__ ,_ ._,_.
<br />
<br />,,,,,,'Jr"'Il',eU'n,,1 I". clo.n01 bu,i"e..
<br />;'~..~ \ "...,j nor /)c 'cvc<'lled if Ih" "nd""'gned dU"1
<br />
<br />~=--=---o.c;-=---::...--= ';=~=:::c:.=---:"",-----=:::~_--=-=::"'-=;:'=,===--:-':"',_,:-~,,-~c.--""
<br />
<br />),5HH
<br />
<br />L1AIIILlTIES AND Nil WORTH
<br />
<br />Nott! f'oyobl, '0 !onkl-Suured (Schedul. \I I
<br /> U"J.(I.".d 15ch,dul. I) 10 000.
<br />.,tJol!.!..!..l?yob!. Ie I.leli...,
<br />ACCOvnl1 and No.e1 Poyabl. to Of h.,.
<br />hntl ond Inl"eJI Ov. ---
<br />Tou, Due (Sch.dul. 51
<br />Lielll on ..o! Ellal. (S,IIedl,ll. 5~ i .8DD.__
<br />Olh.r t'obiljl;1tI llt.miz.) .
<br /> ,
<br />--.'---
<br />--_.
<br />_n' -.... ...--.--" ,-
<br /> TOTAL L1A8ItmES 66~'~B~-
<br />...-.---
<br />
<br />00
<br />
<br />>;:.-;-2-~;~;..~~_~~-;;:.-.:.---=:;:..===.:.=:--:::~-...::===::~-=-.._
<br />
<br />-E
<br />
<br />206.!,9~:
<br />I~~
<br />- ,
<br />'1,0( S,ocb arid Sandi lSth.d"l. 4) - J
<br />0;; t.lot. (~f.~;rv':"21___________+-=~-=-~+1~'~1QUO
<br />:'''''''''.'=-''-'..'', I 1- lEl';f
<br />...' "''-''~!.J.I~'_:~L
<br />" 1 r -----r-2'50-;GOO
<br />-'.--_....~~ --_._-~-._----._----- -.
<br />- --- --------
<br />
<br />--~
<br />,......_...-~-l
<br />I I NET WOlTH
<br />__0_.D6~J30~_ ~,",~~I~~~fT WORTk
<br />
<br />I CONTONQfNT "40'''TO''
<br />
<br />_~...9.2:.~~..:!....~~~'~_________._______
<br />
<br />:.:.~.~~?~? _o,,~_n_~~~~. ~~~f..~~~_~.______
<br />
<br />:..?.':~!.!.:.._~.!....!3..'?.,!-!.01,,' i.,.;~ab). 15~n~d,::,16 n
<br />
<br />"r. S""e,,d.1 V ell.. 0 ltl. 11l.uronc. (5(h.dvl. J)
<br />
<br />,
<br />r~ 701~-602~OO
<br />
<br />INCOME
<br />
<br />G.nero
<br />
<br /> -.
<br /> , I A. fl'ldon.r or Co.Mohr ,
<br /> I -
<br /> ------- r CO'llloCh
<br /> '-~6 7nn 0, leoH' " -
<br />-~_.. ---
<br /> legal (1(J;ml -,
<br />--..---- -/-ri,26.Q... Inca.'" To.
<br />.--------------- --!.'~o...jt~~_lor fed~rol
<br /> Otl'>u Special Debl
<br /> ~--- ._-~,.~-_.~ -
<br />--- 196,Q(,O i
<br /> ,-- -
<br /> INSURANCE COVE/tAor (OMllleJlISON 0' MONTHLY INeOMI 4ND lXJIIIHSIJ
<br /> , N.t Mo<lfllly '",om. ,
<br /> lefll or Horn. Poy",.nl . ,
<br />Hlec" 0" ,",V'OI -
<br />bilu food and Vlilit;..
<br />-
<br />, IMid.Mol,
<br />, Public . Av'J. AmI. Paid on Op..n A<c;..
<br /> TOtAL EXPENSES . S
<br /> - DlfnUNCf aETWEEN INCOME ....NO EX'ENSES I I
<br /> --
<br />
<br />:~:'!....
<br />
<br />'(l ~. ':::~_~:'_':.:~~}~~_~
<br />~'.~~.~~"-~~~~~_.-
<br />':.1 hlo!e.!."~~_____
<br />
<br />fOTAl INCOME
<br />
<br />..~~~~:.~~~_~I~~
<br />
<br />Hcvul'loJd
<br />
<br />~~'..:;:.':~~~C
<br />F."ono
<br />
<br />JhOf l"lvron'.
<br />
<br />T". '.d.lol 1I:".r.... &onll oj DolloJ dou flQI warranl 'hol t"il fQrm m.ell cu,r.n. 0' lul,,'. feJ.,ol t.gvlalionl, W. urge y<lu to cot'll,,11 will, yo"r bonk'. 0110'".)'1
<br />. '.01",. v... of l1'>il 10'''' in if I pro..nl lormot 0' 'four o....n r,vi,iol'l.
<br />
<br />(SH OfHU SIOfl
<br />
<br />
<br />12-0i)1)-028
<br />
<br />6~/s-P/
<br />
|