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					                                                                                                                           FINANCIAL STATEMENT
                                                                                                                                                 CONFIDENTIAL
                                                                   Important
                                                                                               Update for current loan                                                                                                    Date:
                                                                                               New Submission in conjunction with commercial loan application

                                                                                               Requested amount:___________________                             Purpose:
                                                                                                       I intend to apply for individual credit.
                                                                                                       We intend to apply for joint credit. Initials: ___________________
                                                                                                       Co-Maker/Guarantor of other debt



     Borrower/Applicant                                                                                                                                        Co-Borrower/
                                                                                                                                                               Co-Applicant
                    Soc. Sec.                                                                     Birthdate                                                          Soc. Sec.                                                                     Birthdate


                        D.L. #                                                                                                                                           D.L. #
                     Address:                                                                                                                                         Address:




                   Phone (H)                                                                                                                                        Phone (H)


                  Phone (W)                                                                                                                                        Phone (W)


For the purpose of procuring and maintaining from time to time in any form whatsoever with the above named Bank, for claims and demands against the undersigned, the undersigned submits the following as being a true and acuurate statement of their financial condition on the following date, and agrees that if any change
occurs that materially reduces the means or ability of the undersigned to pay all claims or demands against them the undersigned will immediately and without delay notify the said Bank, and unless the Bank is so notified it may continue to rely upon the statement herein given as a true and accurate statement of the financial
condition of the undersigned as of this date.


                                                                      ASSETS                                                                                                                                                         LIABILITIES
Cash Accounts (See Schedule A)                                                                                                                              Accounts & Bills Due                                                                                                                                                   $0
Savings & Money Markets (See Schedule A)                                                                                                                    Loans on Life Insurance Policies (See Schedule C)                                                                                                                      $0
15yr CRP 07                                                                                                                                                 Notes Payable Banks/Others (< 12 mo. See Schedule E)
U.S. Gov't Securities                                                                                                                                       Unpaid Taxes
Stocks & Bonds (See Schedule B)                                                                                                                             Credit Card debt
Other Investment Accounts                                                                                                                                     - Other
Cash Value Life Insurance (See Schedule C)                                                                                                                    - Other
Account Receivables within 1 year                                                                                                                             - Other
-Other IRA Cash out                                                                                                                                           - Other
-Other                                                                                                                                                        - Other
                                                                            Subtotal Current Assets                                                   $0                                                               Subtotal Current Liabilities                                                                                $0
Vehicles                                                                                                                                                    Vehicles
Machinery & Equipment                                                                                                                                       Machinery & Equipment
Furniture & Fixtures                                                                                                                                        Furniture & Fixtures
-Other                                                                                                                                                       -Other
-Other                                                                                                                                                       -Other
                                                                     Subtotal Intermediate Assets                                                     $0                                                        Subtotal Intermediate Liabilities                                                                                  $0
Personal Residence (See Schedule D)                                                                                                                         R/E Mtgs. Payable-Personal Residence (See Schedule D)
Real-Estate-Other (See Schedule D)                                                                                                                          R/E Mtgs. Other (See Schedule D)
Retirement Accounts                                                                                                                                         Other Debts-itemize
Business Value                                                                                                                                                - Other
-Other                                                                                                                                                        - Other
-Other                                                                                                                                                        - Other
                                                                       Subtotal Long Term Assets                                                      $0                                                           Subtotal Long Term Liabilities                                                                                  $0
                                                                                                                                                                                                                                      Total Liabilities                                                                            $0
                                                                                                                                                                                                                                                Net Worth                                                                          $0
                                                                                             Total Assets                                             $0                                                          Total Liabilities and Net Worth                                                                                  $0
                            SOURCES OF INCOME                                                                                                                                                                         PERSONAL INFORMATION
Salary-Borrower/Applicant                                                                                                                                   Business or Occupation
Salary-Co-Borrower/Co-Applicant
Bonus, Dividends, Comm., Draws                                                                                                                              Partner or Officer in Any Other Venture
Other income-
Other income-                                                                                                                                               The following need not be disclosed if individual
Alimony, Child Support and Maint. Pmts need not be                                                                                                          unsecured credit is desired:
revealed if you do not wish to rely upon it for payment)                                                                                                    Married:                                                            Dependents:
TOTAL                                         Annual Income                                                                                                 Unmarried:
Check one                                     Monthly Income                                                                                                Separated:

                  CONTINGENT LIABILITIES                                                                        (Dollars)                                                          GENERAL INFORMATION                                                           YES                      NO
As Endorser, co-maker or                                                                                                                                    Are you or co-borrower a defendant in any
guarantor                                                                                                                                                   suits or legal actions? (yes/no)
On Leases or Contracts                                                                                                                                      Bank Accounts Carried at:
Legal Claims                                                                                                                                                Account Numbers:
Federal Income Taxes                                                                                                                                        Are you obligated to make Alimony, Support
Other Special Debt                                                                                                                                          or Maintenance payments? (yes/no)
                                                                                                                                                            Have you declared bankruptcy in the last 10 years?
(COMPLETE SCHEDULES ON PAGE 2)
                                                                                                             SCHEDULES
                                                                                                             CONFIDENTIAL

                                                                                           SCHEDULE A OF DEPOSIT ACCOUNTS
ACCOUNT CATEGORY                                           NAME OF INSTITUTION                              CURRENT BALANCE                                      IN NAME OF:              SUBJECT TO DEBT?
Checking Account
Savings Account
Certificates of Deposit
Other MMA


                                                                                           SCHEDULE B OF STOCKS AND BONDS
NAME OF ISSUING CORPORATION                                NO. OF SHARES (If Stock)                                    MARKET VALUE                            REGISTERED IN NAME OF

                                                                                                                    FACE VALUE (If Bond)




                                                                                             SCHEDULE C OF LIFE INSURANCE
ISSUING COMPANY                                                    TYPE            CASH VALUE               DEATH BENEFIT                                  REGISTERED IN NAME OF          AMOUNT OF DEBT




                                                                                                SCHEDULE D OF REAL ESTATE
Title to All Real Estate listed is in my name or co-borrower's name and Unencumbered, Except as Shown hereon.

        TITLE HELD                               DESCRIPTION                           DATE                PURCHASE                      MARKET                ORIGINAL LOAN       CURRENT LOAN       PAYMENT
        IN NAME OF                                                                 ACQUIRED                    PRICE                      VALUE                  BALANCE               BALANCE        AMOUNT
                                                                                                                                                                                                 $0          $0

                                                                                                                                                                                                 $0          $0




                                                                          SCHEDULE E OF NOTES PAYABLE TO BANKS AND OTHERS
                     OWED TO:                                            COLLATERAL                         ORIG BALANCE                                    WHEN DUE      BALANCE DUE     PAYMENT AMOUNT




THE UNDERSIGNED CERTIFIES THAT BOTH SIDES HEREOF AND THE INFORMATION INSERTED THEREIN HAS BEEN CAREFULLY READ AND IS TRUE AND CORRECT.

U.S.C., TITLE 18 SEC. 1014, PROVIDES THAT: "WHOEVER KNOWINGLY MAKES ANY FALSE STATEMENT OR REPORT, OR WILLFULLY OVER VALUES ANY LAND, PROPERTY, OR SECURITY, FOR THE

PURPOSE OF INFLUENCING… THE ACTION OF…(THIS) BANK SHALL BE FINED NOT MORE THAN $5,000 OR IMPRISONED NOT MORE THAN 2 YEARS, OR BOTH."




The Creditor this Financial Statement is offered to is hereby authorized to obtain reports to determine the ongoing creditworthiness of the undersigned,

make all inquiries they deem necessary, & to verify the accuracy of the statements made herein, and is authorized to report on their credit experience

with the undersigned.




                        Borrower/Applicant                                                                  Co-Borrower/Joint Applicant

				
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