FINANCIAL AFFIDAVIT






State of ______________________________ )
County of ____________________________ )

On ______________________ before me, _________________________________, personally appeared Scott Alan Klasky, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument and was sworn and says that the following statement of affiant's income, assets and liabilities is true:

Occupation _______________________________________________________________
Employed By ______________________________________________________________
Business Address ___________________________________________________________
Pay Period ________________________________________________________________
Rate of Pay ________________________________________________________________
Social Security # ____________________________________________________________


ITEM 1: INCOME (Averaged on ______________ basis):
    Average GROSS Wage                                                                   $___________
        Less Deductions  
            Federal Income Tax                             $___________  
            Social Security                                     $___________  
            Other                                                   $___________  
          Total Deductions                                   $___________  
    Minus Total Deductions                   $___________
    Average NET Wage                   $___________
    Plus Other Income  
            _____________________________                   $___________
            _____________________________                   $___________
        TOTAL NET INCOME                   $___________

ITEM 2: ASSETS (Ownership: If joint, allocate equally):
    Cash on hand or in bank                                                                           $___________
    Stocks, bonds, notes                   $___________
    Real estate  
        Home                   $___________
        Other                   $___________
    Automobiles                   $___________
    Other personal property                   $___________
    Other assets           _________________________                   $___________
        TOTAL ASSETS                   $___________

ITEM 3: LIABILITIES
                  Creditor                                         Balance Due                             Monthly
                      Payments
________________________                     $___________                   $___________
________________________                     $___________                   $___________
        TOTAL LIABILITIES                   $___________

ITEM 4: AVERAGE MONTHLY EXPENSES
    Household:                                                                                
        Mortgage or rent payments                   $___________
        Food and grocery items                   $___________
        Utilities                   $___________
    Automobile:  
        Gasoline and oil                   $___________
        Repairs                   $___________
        Insurance                   $___________
    Children's Expenses:  
        Clothing                   $___________
        Medical, dental, prescriptions                   $___________
        School supplies                   $___________
        Other expenses:       ___________________________                   $___________
            TOTAL AVERAGE MONTHLY EXPENSES                   $___________


_____________________________       ____Known     ____Produced ID
Affiant's Signature Type of ID _______________________

WITNESS my hand and official seal.

Signature ______________________________
                          Signature of Notary                                                                 (Seal)