Ingrid Slezak, J.D.
Family Mediation Services

Financial Summary - Assets & Liabilities

Name:

Assets: For all assets, please designate how each asset is titled, and if the asset belonged to you prior to the marriage, the value of the asset at the time of marriage, account numbers (if applicable) and financial institutions. If assets were purchased with funds owned by you prior to the marriage, please identify the amount and source of the funds.

Description	Financial Institution	Account No.	Present Value
Cash
Cash on Hand:
Checking Accounts:
Savings Accounts:
Money Market Accounts:
Credit Union Accounts:
Stocks, Securities, Brokerage Accounts
Bonds:
Promissory Notes:
Trust Assets (include information regarding any trusts in which you are named as a beneficiary):
Life Insurance Policies
	Insurance Co.	Policy No.	Cash Value
Real Property
Address:
Legal Description:
Value:
Description	Institution	Loan No.	Value
First Mortgage:
Second Mortgage:
Equity Lines:
Other Liens:
Equity:
Real Property 2
Address:
Legal Description:
Value:
Description	Institution	Loan No.	Value
First Mortgage:
Second Mortgage:
Equity Lines:
Other Liens:
Equity:
Commercial Real Estate
Address:
Legal Description:
Value:
Description	Institution	Loan No.	Value
First Mortgage:
Second Mortgage:
Equity Lines:
Other Liens:
Equity:
Other Real Estate Investments
	Institution	Loan No.	Value
Equity:
Interests In Deeds Of Trust Or Mortgages
	Institution	Loan No.	Value
Equity:
Rental Contracts
Description:
Value:
Payment Provisions:
Partnership Interests
Partnership Name	Value	Liabilities	Equity
Partnership Name	Value	Liabilities	Equity
Corporate or Business Interests
Business Name
Liabilities
Book Value
Fair Market Value
Corporate or Business Interests 2
Business Name
Liabilities
Book Value
Fair Market Value
Retirement Interest (Please provide the name, address and telephone number of the contact person for each retirement plan)
Description (IRA, Pension, 401(k), Keogh, 403(b) etc.)
Contact Name and Telephone
Address
Date
Loan Balance
Value
Retirement Interest 2 (Please provide the name, address and telephone number of the contact person for each retirement plan)
Description (IRA, Pension, 401(k), Keogh, 403(b) etc.)
Contact Name and Telephone
Address
Date
Loan Balance
Value
Retirement Interest 3 (Please provide the name, address and telephone number of the contact person for each retirement plan)
Description (IRA, Pension, 401(k), Keogh, 403(b) etc.)
Contact Name and Telephone
Address
Date
Loan Balance
Value
Automobiles
Model	Year	VIN No.	Value
Boats, Trailers, Etc.
Model	Year	VIN No.	Value
Personal Property
Description			Value
Liabilities For all liabilities, please designate how each liability is titled, and if the liability existed prior to the marriage, the value of the liability at the time of marriage, account numbers (if applicable) and financial institutions.
Consumer Obligations/Credit Cards
Name	Title	Account No.	Balance Due
Promissory Notes
Name	Title	Account No.	Balance Due
Other Liabilities
Name	Title	Account No.	Balance Due

If you have any questions or would like more information, e-mail us at islezak@ingridslezak.com, or give us a call at 503-241-3777.