EFTA01136153.pdf

FINANCIAL ANALYSIS SUMMARY Leon D. Black President and Managing Member Hamlet Holdings LLC Date PREVIOUS NET WORTH CURRENT SUBMITTED NET WORTH Ditbramat lisibann Comments STATEMENT OF ASSETS U0=4 3(31/15 Please complete the detailed schedules listed for all of the assets, both tangible and intangible. heti by you. your spouse and your Dependent Children. on the appropriate schedule as noted below. Enter the amount as of the date of this Statement. All listed assets must be described fully on the appropriate schedules attached. The -totals" should transfer from the detailed schedules to this summary page. STATEMENT OF LIABILITIES Please complete the detailed schedules listed for all of the liabilities of yoursetl, your spouse and your Dependent Children, on the appropriate schedule as noted below. Enter the amount as of the date of this Statement. Al listed liabdities must be deserted fully on the appropriate schedules attached. The 'totals' should transfer from the detailed schedules to this summary page. EFTA01136153 Schedule A - Cash in Banks Applcant: Loan D. Black Hame(.). Address & Telephone 0 Nansels) APPeallad Accaunil DON hPe al Waal oaxa CImM EFTA01136154 Name(s), Address & Telephone 0 Manx(s) Appearing Account Date Type of Interest Date of Current TOTAL: EFTA01136155 Schedule B • Accounts & Notes Receivable Applicant Leon D. Black Name. Address & Telephone Date Original Unpaid Interest Maturity Collateral Securing Number of Debtor Incurred Amount Balance Rate Date Pur se Account or Note TOTAL: S NOTE THAT AS PART OF RECENT ESTATE PLANNING. LEON D. BLACK ENTERED INTO VARIOUS TRANSACTIONS WITH FAMILY TRUSTS. THESE TRANSACTIONS GIVE RISE TO RECEIVABLES AND PAYABLES BY LEON D. BLACK TO FAMILY GRANTOR TRUSTS FOR WHICH LEON D. BLACK IS GRANTOR FOR INCOME TAX PURPOSES. THESE INTRA•FAMILY TRANSACTIONS ARE ZERO SUM TRANSACTIONS AS ANY RECEIVABLE IS EQUAL TO A PAYABLE. FOR REPORTING PURPOSES. THESE TRANSACTIONS ARE NETTED. EFTA01136156 Schedule C - Stocks, Bonds. Notes & Debentures Applcani. Leon D. Black Name of Issuing Company Type of No. of of Purchase Date of Nome al Annual Curren? Prosy Plebe Dab of EFTA01136157 Marne of Neuing Company Type of Ma. of ff. of PUIChiSO Date of Narne Mnual Cunenl PIoaPPMUgo Date of hl TOTAL: EFTA01136158 SS;Mu11'IP n- BP ininoss InvesimeatA 000ICIAt 1.00A D.131Ek Business Irovtirnen. Type a Ho. ol PveNse Dale of Saw le %el EFTA01136159 Susness Irrresiment Type et ND al Pwcr.,re Oa* et Name in Annual wren '12 / el Ouriness I rt n Pr. Ve NNeh Nei • or, p nl inn. TOTAL: $ EFTA01136160 Schedule E - Real Estate Applicant: Leon D. Black Address Owner of Property Purchase Annual % of Current Value Names of Other ft Street. Clt & Si.. Parcel Lot 11 Record T •e Pricer Date Encumbrances Income Ownereht of % Owned Owners & %Owned. TOTAL: EFTA01136161 Schedule F - Life Insurance Applicant: Leon D. Black Name. Address & Telephone is Policy Date Face Annual Cash Surrender of Insurance Carrier Number Issued Beneficiary(ies) Value Premiums Value TOTAL: $ EFTA01136162 Schedule G - Pension / Retirement Funds Applicant: Leon D. Black Name Appearing Type of Type of Securities Name & Address of Account / Fund Employee Employer Current on Account / Fund Account I Fund Held b Account / Fund Em • lo =r / Institution Number Contributions Contributions Value TOTAL: n= EFTA01136163 Schedule H - Vehicles LA_p_plicant: Leon D. Black Specify if Date of Purchase Model Make & Model Purchase Price! Current Market Value T of Vehicle Cimed'Leased or Lease A• regiment Year of Vehicle Cost of Lease If Owned TOTAL: S EFTA01136164 Schedule I - Other Assets Applicant: Leon D. Black Date of Purchase % of Current Market Other of Asset Purchase Price Ownershl • Value of % Owned Information TOTAL: EFTA01136165 Schedule Accounts Payable Applicant: Leon D. Black Name. Address & Telephone Date Due Interest Monthly Unpaid Number of Creditor Account Number Incurred Date Rate Payment Balance '0 S EFTA01136166 Schedule K - Taxes Payable AppLcart: Leon D. Brack Nature Date Original Fines. Penalties & Total Amount Other Taxin • Authorit of Tax Due Obli • ation Interest, If An Due Information TOTAL S EFTA01136167 Schedule L - Notes & Loans Pavables Applicant: Leon D. Black Name. Address & Telephone Date Original Unpaid Payment Interest Maturity . 41 . nu. I r• so • • • ; • o.• TOTAL $ EFTA01136168 Schedule M - Mortgages Liens Payable on Real Estate Applicant: Leon D. Black Name. Address & Telephone Date Original Monthly Unpaid Interest Maturity Description Position of Number of Creditor! Account if Incurred Amount Pa ment Balance Rate Date Address of Real Estate lien! Mort TOTAL a EFTA01136169 Schedule N - Other Liabilities Applicant: Leon D. Black Name. Address & Telephone Date Original Unpaid Payment Interest Maturity Description amiror TOTAL EFTA01136170 Schedule 0 - Contin aent Liabilities Apptcant Leon D. BIad Name. Address & Telephone Date Original Unpaid Payment Interest Maturity DescantIon anceor Number of Parties Intuited Amount Balance Amount i Ponied Rate Date Conatetal Purpose of Liability TOTAL EFTA01136171