PERSONAL FINANCIAL STATEMENT AS OF: SUBMITTED TO TEXAS STATE BANK SAN ANGELO
PERSONAL STATEMENT OF HOME ADDRESS NAME (co-applicant) HOME ADDRESS
HOME PHONE NUMBER SOCIAL SECURITY NUMBER EMPLOYER ADDRESS OF EMPLOYER
HOME PHONE NUMBER SOCIAL SECURITY NO. EMPLOYER ADDRESS OF EMPLOYER
WORK PHONE NUMBER NAME OF ACCOUNTANT ACCOUNTANT PHONE NUMBER NAME OF ATTORNEY ATTORNEY PHONE NUMBER NAME OF INVESTMENT ADVISOR/BROKER NAME OF INSURANCE ADVISOR
WORK PHONE NUMBER
INSURANCE PHONE NO.
CASH INCOME & EXPENDITURES STATEMENT FOR YEAR ENDED:
ANNUAL INCOME SALARY SALARY C0-APPLICANT BONUSES & COMMISIONS RENTAL INCOME INTEREST INCOME DIVIDEND INCOME CAPITAL GAINS PARTNERSHIP INCOME OTHER INVESTMENT INCOME OTHER INCOME: (list below) AMOUNT ($) $ $ $ $ $ $ $ $ $ $ $ TOTAL INCOME $ ANNUAL EXPENDITURES FEDERAL INCOME TAXES OTHER TAXES RENTAL PAYMENTS MORTGAGE PAYMENTS LOAN PAYMENTS (P&I) PROPERTY TAXES INSURANCE INVESTMENTS CHILD SUPPORT TUITION MEDICAL OTHER LIVING EXPENSES AMOUNT ($) $ $ $ $ $ $ $ $ $ $ $ $ -
TOTAL EXPENDITURES $
NET CASH FLOW $
-
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Personal Financial Statement of:
as of:
Assets Cash - checking accounts (schedule A) Cash - savings accounts (schedule B) Certificates of deposit (schedule C) Money Market Funds (schedule D) Notes & contracts receivable(schedule E) Securities - stocks / bonds / mutual funds (schedule F) Life insurance cash surrender value (schedule G) Retirement, 401k, IRAs, Annuities (schedule H) Stock in Private Companies (schedule I) Homestead & Secondary Residence (schedule J) Investment Real estate (schedule K) Automobiles (schedule L) Personal Property Other assets (schedule M) Total Assets Liabilities Current Debt, Credit cards, Accounts (schedule M) Notes payable (schedule N) Taxes payable Homestead/Secondary Residence Mrtgs. (schedule J) Investment Real Estate Mrtgs. (Schedule K) Other liabilities (enter description below)
Amount in Dollars $ -
$
Amount in Dollars $ -
Total Liabilities Net Worth REPRESENTATIONS AND WARRANTIES
$ $
-
The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue creditor to accept a guarantee thereof. Each of the undersigned represents, warrants and certifies that the information provided herein is true correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in their statement or (2) in the financial condition of any of the undersigned or(3) in the ability of any of the undersigned to perform its (or their) legal obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify you as required above, or if any of the information therein should prove to be inaccurate or incomplete in any material respect, you may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the credit-worthiness of the undersigned. The undersigned authorize any person or consumer reporting agency to give you any information it may have on the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. As long as any obligation or guarantee of the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or other information that the undersigned give you shall be your property.
Signature:
Date:
_________________________________________
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SCHEDULES Cash Held in Banks/Money Market Funds Current Checking Accounts (schedule A) Balance $ $ $ $ $ TOTAL $ Current Balance $ $ $ $ Current Balance $ $ $ $ $ Current Balance $ $ $ $ -
-
Savings Accounts (schedule B)
TOTAL
Certificates of Deposit (schedule C)
TOTAL Money Market Accounts / Funds (schedule D)
TOTAL
Notes Receivable and Contracts held (schedule E) Balance Original From Whom Owing Owing Amount $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTAL $ Securities: stocks / bonds / mutual funds (schedule F) Number of Name of Security Shares Cost $ $ $ $ $ TOTAL
Original Date $ $ $ $ $ $
Monthly Payment -
Maturity Date
-
Market Value $ $ $ $ $ $ -
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Life Insurance (schedule G) Cash Surrender Value $ $ $ $ $ $ -
Insurance Company
Beneficiary
Insured
Death Benefit $ $ $ $ $ -
TOTAL Retirement, 401ks, IRAs, Annuities (schedule H) Number of Name or Type of Account Shares $ $ $ $ $ $ TOTAL Stock in Privately Held Companies (schedule I) Company Name No. of shares % Ownership $ $ $ $ $ TOTAL Homestead/Secondary Residence & Related Debt (schedule J) Amount Description / Location Market Value Owing $ - $ $ - $ TOTAL $ - $ Investment Real Estate/Real Estate Mortgages (schedule K) Description / Location Market Value $ $ $ $ $ $ $ $ $ $ Amt. Owing $ $ $ $ $ $ $ $ $ $ Original Cost $ $ $ $ $ $ $ $ $ $ Invested -
Cost -
Market Value $ $ $ $ $ $ $ -
Est. Market Value $ $ $ $ $ $ -
Original Cost $ $ -
Purchase Date
Monthly Pmt. $ $ -
Interest Rate
Purchase Date
Monthly Pmt. $ $ $ $ $ $ $ $ $ -
Interest Rate
TOTAL
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Automobiles (schedule L) Make/Model/Year
Total
Cost $ $ $ $ $ $
-
Value $ $ $ $ $ $
-
Credit Card & Charge Card Debt (schedule M) Name of Card / Creditor Amt. Owing $ $ $ $ $ $ TOTAL $ Notes Payable (schedule N) Name of Creditor $ $ $ $ $ $ $ $ $ Amount Owing $ $ $ $ $ $ $ $ Original Amount $ $ $ $ $ $ $ $ $ Monthly Payment Interest Rate Secured by (Lien)
TOTAL
Other Assets (schedule M)
Asset
Value
$ $ $ $ $ $ $ $ $ $ $ $ -
TOTAL
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