Instructions for Completing Net Worth Statement

Having been convicted in the United States District Court, you are required to prepare and file with the
probation officer an affidavit fully describing your financial resources, including a complete listing of all assets
you own or control as of this date and any assets you have transferred or sold since your arrest. Amendments
were made to 18 U.S.C. §§ 3663(a)(1)(B)(i), 3664(d)(3), and 3664(f)(2), and Rule 32(b)(4)(F) to clarify that
the assets owned, jointly owned, or controlled by a defendant, and liabilities are all relevant to the court’s
decision regarding the ability to pay. Your Net Worth Statement should include assets or debts that are yours
alone (I-Individual), assets or debts that are jointly (J-Joint) held by you and a spouse or significant other, assets
or debts that are held by a spouse or significant other (S-Spouse or Significant Other) that you enjoy the
benefits of or make occasional contributions toward, and assets or debts that are held by a dependent (DDependent)
that you enjoy the benefits of or make occasional contributions toward.

If you are placed on probation or supervised release (or other types of supervision), you may be periodically
required to provide updated information fully describing your financial resources and those of your dependents,
as described above, to keep a probation officer informed concerning compliance with any condition of
supervision, including the payment of any criminal monetary penalties imposed by the court (see 18 U.S.C.
§ 3603).

Please complete the Net Worth Statement in its entirety. You must answer “None” to any item that is not
applicable to your financial condition. Attach additional pages if you need more space for any item. All entries
must be accompanied by supporting documentation (see Request for Net Worth Statement Financial Records
(Prob. 48A)). Initial and date each page (including any attached pages). Also, sign, date, and attach the
Declaration of Defendant or Offender Net Worth & Cash Flow Statements (Prob. 48D).