Fill and Sign the Prenuptial Agreements Who Needs it and How Do I Make Form

- 1 - ACKNOWLEDGEMENT OF RIGHTS AND OBLIGATIONS RE: PREMARITAL AGREEMENT BETWEEN AND . I , hereby acknowledge my understanding of the following rights and obligations of the parties to a Premarital Agreement under the laws of the State of California: 1.ASSETSCalifornia is a community property state. All property acquired by a married person during their marriage while living in California is presumed to be community property. Upon death or divorce, the value of all community assets is divided equally in terms of value between both spouses.Both marital partners are equal agents of the partnership, and able to bind the partnership if acting within the scope of his or her authority and if acting for the joint benefit of the family. The California community property system adds to joint ownership the right of equal management and control.All benefits which come from either spouse's employment during the marriage are community property to the extent they are earned and/or accrued during the marriage. This can include retirement benefits, pensions, savings plans, stock purchase plans, 401k plans, sick and vacation pay, and stock options. If the benefits are not fully vested at the time of a separation, an allocation is made between the community and separate interests.Separate property is property: a) owned before marriage, b) acquired during marriage by gift or inheritance, or c) acquired after separation. Earnings, income or appreciation from separate property sources remains separate property. If there is a dispute about whether an asset is separate property, you must have proof that you acquired the separate property in one of these ways, and have documentation to trace the separate property back to the original source.If you use separate property to acquire property in joint names during the marriage, you are only entitled to reimbursement for the amount of the separate property contributed (no interest or appreciation) and again, you must be able to trace the contribution back to the separate property source.If you own a business prior to marriage, the community may acquire an interest in the business if the business increases in value during the marriage, depending upon the reason for the increase in value.If you own a home in your own name and community funds are used for mortgage payments or to pay down the principal on a loan, the community will acquire an interest in the appreciation in the value of the property, but only in the ratio that the amount paid on principal bears to the total purchase price. The community will also be reimbursed for the amount paid down on principal.The way you hold title to real property will affect disposition of property upon death of a spouse. For example, property held as joint tenants will automatically become the property of the surviving spouse. Property held as community property or tenants in common will be distributed according to the will or trust of the spouse, or according to the laws governing intestate succession in the absence of a will or a trust. - 2 - 2.DEBTSDebts incurred during the marriage are presumed to be community property. The only debts which would normally not be community property are debts which are completely unrelated to the community (such as debts related to one person's separate property, support obligations, gifts or expenses related to a romantic relationship other than the marriage, or criminal acts which did not have a financial benefit to the community). These means that a spouse could incur a debt for a purpose the other spouse does not approve and it would still be a community debt.Debts incurred before marriage remain the responsibility of the person who originally incurred them. If community funds are used to pay these debts, sometimes there is a right of reimbursement for the community and sometimes not (special rules apply depending upon the type of debt and other assets/income which was available to pay it.)3.DIVISION OF ASSETS AND DEBTS UPON DIVORCEIn dissolution of a marriage, the court is empowered to allocate assets of comparable value to the former husband and wife to make the overall division of the gross marital estate substantially equal. It need not divide each asset. For example, when dividing a business might impair its value, the court will generally preserve the ongoing business interests if the court can still make an overall equal division of the marital estate.If you own a home together and one spouse continues to reside in the home after separation, that spouse could owe "rent" to the community, subject to an offset for payment of the costs of the home.If one spouse pays on community debts after separation, he or she will generally be reimbursed for those payments (the biggest exception would be if the debt payments are in lieu of support.).4. SUPPORTEach spouse owes a duty of support to the other. Support can be ordered after separation. The amount and duration of support is set by the court and can depend on many factors.Spouses are permitted to waive the right to support upon divorce in a premarital agreement. Certain conditions must be met, including that each spouse be represented by an attorney for the premarital agreement. In addition, a court could later order spousal support even if it was waived if it would be unconscionable not to order it.5.CHILDRENEach parent is entitled to custody of the children. Upon a separation, the court determines custody according to the best interest of the child. Child support is payable according to a standardized formula.Premarital agreements cannot waive or change the authority of the court to make orders of the court regarding children.6.PREMARITAL AGREEMENTS - 3 - Under California law, the property rights of husband and wife prescribed by statute may be altered by a premarital agreement.A premarital agreement may be recorded in the office of the recorder of each county in which real property affected by the agreement is situated if the premarital agreement is executed and acknowledged or proved in the manner that a grant of real property is required to be executed and acknowledged or proved. Recording or nonrecording of a premarital agreement or other marital property agreement has the same effect as recording or nonrecording of a grant of real property.Information on the enforceability of premarital agreements is contained in the “Premarital Agreement Disclosure” that was received and signed concurrently with this “Acknowledgement of Rights and Obligations.”7.BY EXECUTING THE PREMARITAL AGREEMENT YOU WILL BE WAIVING ALL OF THE FOLLOWING RIGHTS:You will be waiving your right for the separate property used by one of you to purchase real property you own together not to share in the appreciation or depreciation of such real property. Instead of only community property contributions to the equity in real property appreciating, the separate and community property used to purchase a residence shall appreciate or depreciate together in proportion to the equity of the property.You will also be waiving your right to spousal support in any amount and for any period of time that a court might have deemed just and reasonable.This statement of Rights and Obligations has been provided by .I, , hereby acknowledge receipt of this Declaration of Rights and Obligations on this the day of , 20 Signature Type or Print Name ADVISEMENT AND WAIVER OF RIGHT TO INDEPENDENT COUNSEL RE: PREMARITAL AGREEMENT BETWEEN AND . NAME OF DECLARANT: .RIGHT TO BE REPRESENTED BY AN ATTORNEY. I have been advised to seek independent counsel regarding a proposed premarital agreement between myself and . I am either currently in a position to afford independent counsel of my own choice or, if I can not afford independent legal counsel, I understand that has agreed to compensate me for the cost of independent counsel to act solely under my direction and control. WAIVER. I understand that I am giving up the rights stated above and hereby waive the right to independent counsel.Signature of Declarant Type or Print NameState of CaliforniaCounty of On before me, (here insert name and title of the officer), personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.Signature (Seal) - 1 - PR EM ARIT A L A G REEM EN T D IS C LO SU RE AS S T A TED B ELO W , I T I S V ER Y I M PO RTA NT T H AT Y O U B E R EPR ESE N TED B Y INDEPE N DEN T C O UNSE L, O R W AIV E S U CH R IG HT. S E V EN ( 7 ) D AYS M UST P A SS BE FO RE E X EC UTIO N O F T H E A G REEM EN T A S P R O VID ED B ELO W .NO TIC E:T he p artie s u ndersta n d fu lly th e la w s o f C alif o rn ia d ea lin g w it h th e v alid it y o f p rem arit a l ag reem en ts , i n clu din g, b u t n ot l im it e d t o t h e f o llo w in g:(a ) A p rem arit a l a greem en t is n ot e n fo rcea b le if th e p arty a gain st w hom e n fo rcem en t is so u gh t p ro ves e it h er o f t h e f o llo w in g:(1 ) That p arty d id n ot e x ecu te t h e a greem en t v olu nta rily .(2 ) The a greem en t w as u nco n sc io n ab le w hen i t w as e x ecu te d a n d, b efo re e x ecu tio n of t h e a greem en t, a ll o f t h e f o llo w in g a p plie d t o t h at p arty : ( A )T hat p arty w as n ot p ro vid ed a f a ir , r ea so n ab le , a n d f u ll d is c lo su re o f th e p ro p er ty o r f in an cia l o b lig atio n s o f t h e o th er p arty . ( B )T hat p arty d id n ot v olu nta rily a n d e x p ressly w aiv e, in w rit in g, a n y rig h t t o d is c lo su re o f t h e p ro p erty o r f in an cia l o b lig atio n s o f t h e o th er pa rty b ey on d t h e d is c lo su re p ro vid ed . ( C )T hat party did not have, or rea so n ab ly co u ld not have had , an adeq uate k now le d ge o f th e p ro p erty o r fin an cia l o b lig atio n s o f th e oth er p arty .(b ) A n is su e o f u nco n sc io n ab ilit y o f a p rem arit a l a greem en t s h all b e d ecid ed b y t h e c o u rt as a m atte r o f l a w .(c ) For th e p u rp ose s o f s u bdiv is io n (a ), it s h all b e d eem ed th at a p rem arit a l a greem en t wa s n ot e x ecu te d v olu n ta rily u nle ss th e c o u rt fin ds in w rit in g o r o n th e r eco rd a ll o f th e f o llo w in g: (1 ) The party again st whom en fo rcem en t is so u gh t was rep rese n te d by in dep en d en t le g al c o u n se l a t th e tim e o f s ig n in g th e a greem en t o r, a fte r b ein g ad vis e d to se ek in dep en den t le g al co u nse l, ex p ressly w aiv ed , in a se p ara te wr it in g, r e p rese n ta tio n b y i n dep en den t l e g al c o u n se l. ( 2 ) The party again st w hom en fo rcem en t is so u gh t had not le ss th an se v en cale n dar days betw ee n th e tim e th at party w as fir st prese n te d w it h th e ag reem en t a n d a d vis e d to se ek in dep en den t le g al co u nse l a n d th e tim e th e ag reem en t w as s ig n ed . - 2 - (3 ) The p arty again st w hom en fo rcem en t is so u gh t, if u nrep rese n te d b y le g al co u nse l, w as fu lly in fo rm ed o f th e te rm s a n d b asic e ffe ct o f th e a greem en t a s we ll as th e rig h ts an d ob lig atio n s h e or sh e w as giv in g u p b y sig n in g th e ag reem en t, a n d w as p ro fic ie n t in t h e la n gu age in w hic h t h e e x p la n atio n o f t h e pa rty 's rig h ts w as co n ducte d a n d in w hic h th e a greem en t w as w rit te n . T he ex p la n atio n o f t h e r ig h ts a n d o b lig atio n s r elin quis h ed s h all b e m em oria liz ed in writ in g an d deliv ered to th e party prio r to sig n in g th e agreem en t. T he un rep rese n te d party sh all, on or befo re th e sig n in g of th e prem arit a l ag reem en t, ex ecu te a docu m en t decla rin g th at he or sh e receiv ed th e in fo rm atio n req uir ed b y th is p ara gra p h an d in dic a tin g w ho p ro vid ed th at in fo rm atio n . ( 4 ) The a greem en t a n d th e w rit in gs e x ecu te d p ursu an t to p ara gra p hs (1 ) a n d (3 ) we re n ot e x ecu te d u nd er d uress, f r a u d, o r u ndue in flu en ce, a n d t h e p artie s d id not l a ck c a p acit y t o e n te r i n to t h e a greem en t. ( 5 ) A ny o th er f a cto rs t h e c o u rt d eem s r ele v an t. W E H AVE F U LLY R EA D A ND U NDER ST A N D T H E A BO VE L A W S A ND W ER E PR O VID ED TH IS DIS C LO SU RE, A CO PY O F TH E PR O PO SE D PR EM ARIT A L AG REEM EN T A ND W ER E A DVIS E D T O S E EK I N DEPE N DEN T C O UNSE L A T L EA ST SEV EN ( 7 ) D A YS B EFO RE E X EC UTIO N O F T H E A CTU AL A G REEM EN T .H USB A ND T O B E W IF E T O B E D ATE S IG NED M UST B E A T L EA ST S E V EN D AYS B EFO RE S IG NIN G T H E A GREEM EN T. - 1 - PR EM ARIT A L A G REEM EN T TH IS P R EM ARIT A L A GREEM EN T ( “ A gre e m en t” ), m ad e t h is d ay o f , 2 0 AAA, is b etw een (“ H usb an d”), h av in g a n a d dre ss a t , a n d (“ W if e ” ),h av in g a n ad dre ss a t . W I T N E S S E T H W HER EA S, th e p artie s are ab out to co ntr a ct m arria g e an d ex ecu te th is A gre em en t in conte m pla tio n o f m arria g e to b e e ffe ctiv e u pon th eir m arria g e in a cco rd an ce w ith th e la w s o f th e Sta te o f C alif o rn ia , in clu din g a n y U nif o rm P re m arita l A gre em en t A ct, o r o th er a p plic ab le la w s, ad opte d b y t h e S ta te o f C ali f o rn ia ;W HER EA S, th e p artie s d esir e to a lte r th eir p ro perty r ig hts p re sc rib ed b y C alif o rn ia s ta tu te fo r m arrie d c o u ple s b y e n te rin g t h is A gre em en t r e g ard in g c erta in p ro pertie s, r e sp onsib ilitie s, d utie s an d o bli g atio ns in clu din g b ut n ot lim ite d to a n y in te re st, p re se n t o r f u tu re , le g al o r e q uita b le , v este d or c o ntin gen t, i n r e al o r p ers o nal p ro perty , i n clu din g i n co m e a n d e arn in gs; W HER EA S, n eith er p arty h as b een m arrie d n or h as c h ild re n ; a n dW HER EA S, th e p artie s h av e fu rn is h ed e ach o th er w ith a fin an cia l sta te m en t w hic h e ach party a ck now le d ges is a fu ll a n d c o m ple te d is c lo su re o f s u bsta n tia lly a ll o f th e re al a n d p ers o nal pr o perty n ow o w ned b y h im o r h er a n d a g re e th at th e v alu es a re a n e stim ate b y h im o r h er o f th e ap pro xim ate p re se n t v alu e o f th e p ro perty . A ll p ro perty lis te d is n ow an d sh all co ntin ue to b e se p ara te p ro pertie s o f th e re sp ectiv e p artie s. O rig in als o r c o pie s o f sa id fin an cia l sta te m en ts a re atta ch ed h ere to a s E xhib its " A " a n d " B ." N OW , T H ER EFO RE, t h e p artie s a g re e a s f o llo w s: 1 . Calif o rn ia c o m munit y p ro perty la w s h all a p ply to th e p artie s a s o f th eir m arria g e e x cep t a s pro vid ed i n t h is A gre em en t.2 . In t h e e v en t o f d is so lu tio n o f t h e m arria g e o r d eath o f a p arty , a n y p ers o nal p ro perty u se d f o r a d ow np ay m en t o n r e al p ro perty s h all s h are i n t h e a p pre cia tio n o r d ep re cia tio n o f s u ch r e al p ro perty in p ro po rtio n t o i ts s h are i n t h e e q uity o f t h e r e al p ro perty .3. Title to a n y p ro perty p urc h ase d b y th e p artie s sh all b e h eld a s te n an ts in c o m mon. T he am ount o f e ach p arty ’s u nd iv id ed i n te re st i n a n y s u ch c o -o w ned r e al p ro perty s h all b e i n p ro portio n to th eir c o ntr ib utio n to w ard e q uity in th e p ro perty . N eith er p arty sh all b e p erm itte d to se ll th eir in te re st i n a n y r e al p ro perty t h e p artie s o w n t o geth er w ith out t h e s ig natu re o f b oth p artie s.3 . To t h e e x te n t p erm itte d b y l a w , b oth p artie s h ere b y w aiv e t h eir r ig ht t o a n y c la im o f s p ousa l su pport in any amount and for any period of time that a court might have deemed just and reasonable.4. This A gre em en t s h all b e c o ntr o lle d , c o nstr u ed a n d g iv en e ffe ct b y a n d u nder t h e l a w s o f t h e - 2 - Sta te o f C alif o rn ia . T his p ro vis io n s h all c o ntin ue i n e ffe ct e v en i f t h e p artie s a re d om ic ile d i n a s ta te oth er th an C alif o rn ia . It is th e in te n t o f th e p artie s th at th is A gre em en t b e e n fo rc ed to th e fu lle st ex te n t perm is sib le under ap plic ab le la w s an d public polic ie s. The in valid ity , ille g ality , or un en fo rc eab ility o f a n y p artic u la r p ro vis io n o f th is A gre em en t s h all n ot a ffe ct th e o th er p ro vis io ns, an d th is A gre em en t s h all b e c o nstr u ed in a ll re sp ects a s if s u ch in valid , ille g al, o r u nen fo rc eab le pro vis io n h ad b een o m itte d .5 . This A gre em en t c o n stitu te s t h e e n tir e a g re em en t b etw een t h e p artie s p erta in in g t o i ts s u bje ct ma tte r a n d it s u pers e d es a ll p rio r c o nte m pora n eo us a g re em en ts , r e p re se n ta tio ns a n d u nders ta n din gs of th e p artie s. N o su pple m en t, m odif ic atio n o r am en dm en t o f th is A gre em en t sh all b e b in din g un le ss e x ecu te d i n w ritin g b y b oth p artie s.6 . No w aiv er o f a n y p ro vis io n o f th is A gre em en t s h all b e d eem ed , o r s h all c o nstitu te , a w aiv er of a n y o th er p ro vis io n, w heth er o r n ot s im ila r, n or s h all a n y w aiv er c o nstitu te a c o ntin uin g w aiv er. No w aiv er s h all b e b in din g u nle ss e x ecu te d i n w ritin g b y t h e p arty m ak in g t h e w aiv er.7 . This A gre e m en t sh all be bin din g upon th e partie s here to an d upon th eir re sp ectiv e ex ecu to rs , a d m in is tr a to rs , l e g al r e p re se n ta tiv es, s u ccesso rs , a n d a ssig ns.8 . This A gre em en t m ay o nly b e a m en ded o r re v oked b y w ritte n a m en dm en t s ig ned b y b oth partie s.9 . Each p arty f u rth er a g re es a n d a ffir m s:(a ) I e x ecu te d t h is A gre em en t v olu nta rily ; w ith out d ure ss, f ra u d, o r u ndue i n flu en ce;(b ) I d o n ot c o nsid er t h is A gre em en t u nco nsc io nab le ; a n d(c ) prio r t o e x ecu tio n o f t h is A gre em en t, I w as p ro vid ed a f a ir a n d r e aso nab le d is c lo su re of t h e p ro perty a n d f in an cia l o blig atio ns o f t h e o th er p arty .A G REED :H USB A ND ( a s u se d i n t h is A gre em en t) W IF E ( a s u se d i n t h is A gre em en t) A P PRO VED A tto rn ey f o r H usb an dA P PRO VED A tto rn ey f o r W if eN ote : T his A gre em en t m ust b e e x ecu te d b efo re a n ota ry p ublic . - 3 - State of CaliforniaCounty of On before me, (here insert name and title of the officer), personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.Signature (Seal)State of CaliforniaCounty of On before me, (here insert name and title of the officer), personally appeared , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.Signature (Seal) Financial Statement Disclosure Information This financial statement disclosure is for use in connection with a premarital agreement and should be completed accurately and completely. This statement should contain a full disclosure of all your assets and liabilities. You should initial each page and sign the last page. Your prospective spouse should also sign the last page acknowledging receipt.Both persons must complete a separate financial statement and provide it to the other party. Two forms are enclosed, one for each party.This form can be completed in Word or printed and completed by hand.If you require additional space, please attach additional pages for the sections you need to expand. Financial Statement page - 1 - Initials: _________ PE R SO NAL F IN ANCIA L D IS C LO SU RE S T A TEM EN T ****************************************************** To: Date: Individual InformationName: Address: City: State:,,Zip Occupation: Phone: Current AssetsCurrent LiabilitiesCash on Hand or in Banks Notes Payable (Secured)(Schedule F) Other Cash: Notes Payable (Unsecured)(Schedule G) Real Estate (other than residence Schedule A) Real Estate Mortgages Payable (Schedule H) Residence Auto Loans (Schedule I) Motor Vehicles (Schedule B) Unpaid Taxes and Interest US Government Securities (Schedule C) Due to Brokers Non-Marketable Securities (Schedule D) Open Accounts Stocks (Schedule E) Credit Cards (List): Other Personal Property Visa Life Insurance Cash Value Business IRA Notes Receivable Other Assets:Other:Personal IRA Antiques Partnership Assets Residential Mortgage Total Liabilities TOTAL OF ALL ASSETS LESS TOTAL OF ALL LIABILITIES NET WORTH Total Assets Individual Income Information (Annual)Salary Bonus Commissions Dividends Rental Income Other Income (List): Total Income Contingent LiabilitiesGuarantor, Co-maker Lease or Contracts Legal Claims Other: SCHEDULE “A” REAL ESTATEDescription of Real Estate Cost Market Value Date Acquired Financial Statement page - 2 - Initials: _________ Totals SCHEDULE “B” MOTOR VEHICLESDescription of Motor Vehicles Cost Value Totals SCHEDULE “C” U.S. GOVERNMENT SECURITIESDescription of Stock or Bond Date AcquiredPar ValueMarket Value Totals SCHEDULE “D” NON MARKETABLE SECURITIESDescription Date AcquiredPar ValueMarket Value Totals SCHEDULE “E” STOCKSCompanySharesDate AcquiredPar ValueMarket Value Totals SCHEDULE “F” NOTES PAYABLE SECUREDDescription Date BalancePayment (m/yr) Totals SCHEDULE “G” NOTES PAYABLE UNSECUREDDescription Date BalancePayment (m/yr) SCHEDULE “H” REAL ESTATE MORTGAGESDescription Date BalancePayment (m/yr) Totals SCHEDULE “I” AUTO LOANSDescription Date BalancePayment (m/yr) Totals CERTIFICATION TO FINANCIAL STATEMENT I certify this Statement to be true and correct as of the date indicated; that this financial statement is a full and Financial Statement page - 3 - Initials: _________ fair disclosure of my assets; and that I provided a true and correct copy of this financial statement to ___________________________________ on ___________________. SignatureDate: _______________________I _ _ ____ _______________ ______________ a ck now le d ge r e ceip t o f t h is f in an cia l s ta te m en t a n d d is c lo su re .__ _____ _______________ __________________ Sig natu reDa te : _ _ _ _______________ ____ Financial Statement page - 1 - Initials: _________ PE R SO NAL F IN ANCIA L D IS C LO SU RE S T A TEM EN T ****************************************************** To: Date: Individual InformationName: Address: City: State:,,Zip Occupation: Phone: Current AssetsCurrent LiabilitiesCash on Hand or in Banks Notes Payable (Secured)(Schedule F) Other Cash: Notes Payable (Unsecured)(Schedule G) Real Estate (other than residence Schedule A) Real Estate Mortgages Payable (Schedule H) Residence Auto Loans (Schedule I) Motor Vehicles (Schedule B) Unpaid Taxes and Interest US Government Securities (Schedule C) Due to Brokers Non-Marketable Securities (Schedule D) Open Accounts Stocks (Schedule E) Credit Cards (List): Other Personal Property Visa Life Insurance Cash Value Business IRA Notes Receivable Other Assets:Other:Personal IRA Antiques Partnership Assets Residential Mortgage Total Liabilities TOTAL OF ALL ASSETS LESS TOTAL OF ALL LIABILITIES NET WORTH Total Assets Individual Income Information (Annual)Salary Bonus Commissions Dividends Rental Income Other Income (List): Total Income Contingent LiabilitiesGuarantor, Co-maker Lease or Contracts Legal Claims Other: SCHEDULE “A” REAL ESTATEDescription of Real Estate Cost Market Value Date Acquired Financial Statement page - 2 - Initials: _________ Totals SCHEDULE “B” MOTOR VEHICLESDescription of Motor Vehicles Cost Value Totals SCHEDULE “C” U.S. GOVERNMENT SECURITIESDescription of Stock or Bond Date AcquiredPar ValueMarket Value Totals SCHEDULE “D” NON MARKETABLE SECURITIESDescription Date AcquiredPar ValueMarket Value Totals SCHEDULE “E” STOCKSCompanySharesDate AcquiredPar ValueMarket Value Totals SCHEDULE “F” NOTES PAYABLE SECUREDDescription Date BalancePayment (m/yr) Totals SCHEDULE “G” NOTES PAYABLE UNSECUREDDescription Date BalancePayment (m/yr) SCHEDULE “H” REAL ESTATE MORTGAGESDescription Date BalancePayment (m/yr) Totals SCHEDULE “I” AUTO LOANSDescription Date BalancePayment (m/yr) Totals CERTIFICATION TO FINANCIAL STATEMENT Financial Statement page - 3 - Initials: _________ I certify this Statement to be true and correct as of the date indicated; that this financial statement is a full and fair disclosure of my assets; and that I provided a true and correct copy of this financial statement to ___________________________________ on ___________________. _________________________________SignatureDate: ___________________________I _ _ ____ _______________ ______________ a ck now le d ge r e ceip t o f t h is f in an cia l s ta te m en t a n d d is c lo su re .__ _____ _______________ __________________ Sig natu reDa te : _ _ ________________ _________________