OPROB 48D (Rev. 9/00) DECLARATION OF DEFENDANT OR OFFENDER NET WORTH & CASH FLOW STATEM ENTS I, , residing at ,in the city (or county) of , in the state of ,have completed the attached Net Worth Statement (Prob. Form 48) or Net Worth Short Form Statement (Prob. Form 48EZ) and/or Cash Flow Statement (Prob. Form 48B) that fully describe my financial resources, including a complete listing of all assets owned or controlled by me as of this date and any transfers or sales of assets since my arrest. The Cash Flow Statement (Prob. Form 48B) also includes my financial needs and earning ability and the financial needs and earning ability of my spouse (or significant other) and my dependent(s) living at home. Net Worth Statement (Total pages, including additional pages ) Net Worth Short Form Statement (Total pages, including additional pages ) Cash Flow Statement (Total pages, including additional pages ) I declare under penalty of perjury that the foregoing is true and correct; or False statements may result in revocation of supervision, in addition to possible prosecution under the provisions of 18 U.S.C. 1001, which carries a term of imprisonment of up to 5 years and a fine of up to $250,000, or both. (Defendant Signature) Executed on day of , .