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PROB 48D Rev. 07/13 DECLARATION OF DEFENDANT OR OFFENDER NET WORTH CASH FLOW STATEMENTS 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. I declare under penalty of perjury that the foregoing is true and correct. 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 Print Save As. 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. 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. I declare under penalty of perjury that the foregoing is true and correct. False statements may result in revocation of supervision in addition to possible prosecution under the provisions of 18 U*S*C. I declare under penalty of perjury that the foregoing is true and correct. 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 Print Save As. 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. I declare under penalty of perjury that the foregoing is true and correct. False statements may result in revocation of supervision in addition to possible prosecution under the provisions of 18 U*S*C. 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. I declare under penalty of perjury that the foregoing is true and correct. 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 Print Save As.

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