Name of party seized by Was party who made seizure a secured creditor? Yes No Form of security? Do you expect to receive any sums of money, or any other property within the next 12 months, which are not related to your normal Yes No income? Within the last five (5) years, while you knew yourself to be insolvent, Yes No have you sold, disposed of, or transferred any real estate? Description Disposition of Date Disposed To Whom Proceeds of Asset Proceeds Within the last five (5) years, while you knew yourself to be insolvent, Yes No have you made any gifts to relatives or others in excess of $500.00? (a) Please list the banks that you are currently dealing with: Amount Bank Address City Postal Code Currently In Account (b) Do you have a safety deposit box? Yes No If so, which bank? Please provide details of the contents:
Name of party seized by Was party who made seizure a secured creditor? Yes No Form of security? Do you expect to receive any sums of money, or any other property within the next 12 months, which are not related to your normal income? Yes No Within the last five (5) years, while you knew yourself to be insolvent, have you sold, disposed of, or transferred any real estate? Yes No Description of Asset Date Disposed To Whom Proceeds Disposition of Proceeds Within the last five (5) years, while you knew yourself to be insolvent, have you made any gifts to relatives or others in excess of $500.00? Yes No (a) Please list the banks that you are currently dealing with: Bank Address City Postal Code Amount Currently In Account (b) Do you have a safety deposit box? Yes No If so, which bank? Please provide details of the contents: