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Page 2 Form 10>1980 <br />Rev 6-1985 <br />Rev 8-1990 <br />4. Llat any real estate you or your spouse own or are buying <br />other than your home. If anyi ______________________________ <br />Estimated market value from real estate tax statement} <br />5. If you have not made all of the payments on your home, list <br />your monthly payments} $_________________ per month. <br />6. List your current year's property tax: 19_ _ 8_ _ _ _ _ _ _ <br />7. List all of your assetsi <br />Cash on hand $_ _ _ _ _ _ _ _ __ _ <br />Savings accounts <br />(Whether in trust, joint tenancy or <br />sole ownership) $. <br />Stocks, bonds or securities <br />Life Insurance <br />ANT OTHER ASSETS <br />List any special monthly expenses you might have. For <br />example, medical expenses, special diet, utilities, work <br />expenses, etc. _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />9. If you wish to, describe the reason it is a hardship for you <br />to pay the special assessments against your property. _ _ _ <br />I BATE READ THE FOREGOING STATEMENTS AND THE ASSV. I BATE HADE, <br />AND I DECLARE THEM TO BE THOB AND CORRECT TO THE BEST OF MT <br />EEOflLEDGE. <br />Signature of Applicant Date <br />Signature of h Date