Request for Fee Waiver USCIS Form I-912

9. TAX REFUND 10. LIFE INSURANCE WITH CASH SURRENDER OR LOAN VALUE (Attach copy of declaration page for each policy.) SCHEDULE OF ASSETS AND DEBTS (Family Law) FL-142 [Rev. January 1, 2005] Page 2 of 4 $$ AMOUNT OF MONEY OWED OR ENCUMBRANCE CURRENT GROSS FAIR MARKET VALUE SEP. PROP DATE ASSETS DESCRIPTION ACQUIRED ITEM NO. ................
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