I Amount Existing Liens I=I Other (explain): Property will be: a Primary Residence No. 01 Unite 1 I You Eta 2002 rt Secondary uu Residence El Investment $ $ I (a) Present Value of Lot $ this line II this Is s refinance loon. Year Acquired Original Cost Amount Existing Liens Purpose of Refinance

source of Funds, Primary industry of source of Wealth/Source of Funds' Summarize Source of Wealth: 1 DOther: E Business Owner III Salary/Earnings El Investment El Inhentance/Grfts Further Describe Source of Wealth /Detail the history d wealth for each of the sources: (e.g. For trusts, how did settlor accumu