2013-Form FDA-1
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ABCDEFG
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FORM FDA-1 (10/83)NAME:
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GUAMMAILING
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FINANCIAL DISCLOSURE ACTADDRESS:
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TITLE IV, CHAPTER 13TELEPHONE #:
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GUAM CODE ANNOTATEDTITLE:
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STATEMENT OF ASSETS AND LIABILITIES
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As of December 31, 2012
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Column AColumn B
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ASSETS:ScheduleCost BasisEstimated Value Basis
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Cash1-A$0.00$0.00
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Receivables1-B0.000.00
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Marketable Securities1-C0.000.00
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Cash Value of Life Insurance1-D0.000.00
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Net Assets of Proprietorships1-E0.000.00
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Interest in Net Assets of Corporations,
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Partnerships, Joint-Ventures1-F0.000.00
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Residence
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Investment in Real Estate1-G0.000.00
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Present Value of Future Interests1-H0.000.00
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Other Assets1-I0.000.00
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TOTAL ASSETS$0.00$0.00
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LIABILITIES:
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Accounts Payables and Accrued Expenses1-J$0.00$0.00
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Notes Payable-Unsecured1-K0.000.00
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Notes Payable-Secured1-L0.000.00
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Accrued Income Taxes Payable
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Deferred Income Taxes on Unrealized
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Asset Appreciation
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Other Liabilities1-M0.000.00
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TOTAL LIABILITIES$0.00$0.00
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EXCESS OF ASSETS OVER LIABILITIES$0.00$0.00
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Under penalties of perjury, I declare the above Statement of Assets and Liabilities and accompanying
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schedules are stated accurately and include all income from all sources for the year indicated for
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myself, my spouse and my dependents.
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SIGNED:
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DATED:
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Appendix I
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Stmt Asset & Liab
Schd 1-A to D
Schd 1-E to H
Schd 1-I to M
Stmt of Inc
Schd 2-A to D
Schd 2-E to H
Schd 2-I to J
Stmt Rec & Disb
Schd 3-A
Schd 3-B
Sheet1
Sheet2