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DIRECTIONS DIRECTIONS FOR COMPLETING THE PREMIER BANK

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DIRECTIONS DIRECTIONS FOR COMPLETING THE PREMIER BANK Powered By Docstoc
					DIRECTIONS FOR COMPLETING THE PREMIER BANK PERSONAL FINANCIAL STATEMENT:

NOTE: PLEASE MAKE SURE YOUR HAVE OPENED/EXPANDED YOUR MICROSOFT EXCEL WINDOW
        AND THAT YOU ARE ABLE TO VIEW THE TABS AT THE BOTTOM OF THIS SPREADSHEET.

      1) BEGIN ON PAGE 1 (SECOND TAB)

      2) COMPLETE APPLICANT'S INFORMATION
         (INCLUDING INDIVIDUAL AND/OR JOINT PARTY INFORMATION)

      3) COMPLETE THE FOLLOWING SECTIONS:
              A) ANNUAL INCOME
              B) ESTIMATE OF ANNUAL EXPENSES
              C) GENERAL INFORMATION
              D) CONTINGENT LIABILITIES

      4) COMPLETE SCHEDULES A THROUGH H
         (BEGINS ON PAGE 1, CONTINUE TO PAGE 2 (TAB 3))

  IF YOU COMPLETE SCHEDULES A THOUGH H, ASSETS, LIABILITIES & NET WORTH
                     SHOULD CALCULATE ON ITS OWN.
                 Applicant's Name & Address                                                   Premier Bank                           TYPE OF CREDIT
                                                                                             P. O. Box 3606                             Individual
                                                                                       Tallahassee, Florida 32315                       Joint, with
                                                                                             (850) 386-2225                             Information on separate financial
                                                                                                                                        statement relationship

Statement of Financial Condition as of:
                                   Individual Information                                                                                         Joint Party Information
Business or Occupation                                                                                   Business or Occupation
Employer's Name & Add                                                                                    Employer's Name & Add


Length of Employment                                                                                     Length of Employment
Home Phone                                               Bus. Phone                                      Home Phone                                                 Bus. Phone
Email Address                                                                                            Email Address
Date of Birth                                            SS #                                            Date of Birth                                              SS #

                                                                                        PLEASE COMPLETE SCHEDULES FIRST
                          ASSETS - Summary from Schedules                                                                             LIABILITIES - Summary from Schedule
Cash on Hand and In Bank                                         Sched. A       $                -       Notes Due to Banks                                         Sched. A       $                    -
Cash Value of Life Insurance                                     Sched. B       $                -       Notes Due to Relatives and Friends                         Sched. H       $                    -
U.S. Gov. Securities                                             Sched. C       $                -       Notes Due to Others                                        Sched. H       $                    -
Other Marketable Securities                                      Sched. C       $                -       Accounts and Bills Payable                                 Sched. H       $                    -
                                                                                $                -       Loans on Life Ins Policy                                   Sched. B       $                    -
                                                                                $                -       Contract Accounts Payable                                  Sched. H       $                    -
                                                                                $                -       Cash Rent Payable                                                         $                    -
                                             TOTAL LIQUID ASSETS $                               -       Other Liabilities Due within 1 year - Itemize                             $                    -
Real Estate Owned                                                Sched. E $                      -
Mortgages & Contracts Owned                                      Sched. F $                      -
Notes & Accounts Receivable - current                            Sched. D $                      -
Notes & Accounts Receivable - over 90 days                       Sched. D $                      -                                    TOTAL SHORT TERM LIABILITIES $                                    -
Notes Due From Relatives and Friends                             Sched. D $                      -       Real Estate Mortgages Payable                              Sched. E       $                    -
Other Securities - Not Readily Marketable                        Sched. C $                      -       Personal Property Debts Payable                            Sched. G       $                    -
Personal Properties                                              Sched. G $                      -       Other Debts - Itemize                                                     $                    -
IRA and Tax Deferred Accounts                                                   $                -                                     TOTAL LONG TERM LIABILITIES $                                    -
Other Assets - Itemized                                                         $                -       Total Liabilities                                                         $                    -
                                     TOTAL PRODUCTIVE ASSETS $                                   -       Net Worth (Total Assets Minus Total Liabilities)                          $                    -
TOTAL ASSETS                                                 $                                   -       TOTAL LIABILITIES AND NET WORTH                                           $                    -

                                       ANNUAL INCOME                                                                                       ESTIMATE OF ANNUAL EXPENSES
Salary, Bonuses and Commissions                                                                          Income Taxes
Dividends and Interest                                                                                   Other Taxes                                                               $                    -
Rental and Lease Income (Net)                                                                            Insurance Premiums
Alimony, child support, or separate maintenance income need not be revealed if                           Mortgage Payments
you do not wish to have it considered as a basis for repaying                                            Rent Payable                                                              $                    -
this obligation. Other Income - Itemized                                        $                -       Other Expenses
Provide the following information only if Joint Credit is checked above.
Other Person's Salary, Bonuses and Commissions
Alimony, child support, or separate maintenance income need not be revealed if
you do not wish to have it considered as a basis for repaying
this obligation. Other Income of Other Person - Itemized                        $                -
TOTAL                                                                           $                -       TOTAL                                                                     $                    -

                                     GENERAL INFORMATION                                                                                           CONTINGENT LIABILITIES
Are any Assets Pledged Other Than Those listed on Schedules?                                             As Endorser, Co-Maker or Guarantor
                                 YES                                      NO                                                    YES                                          NO
Are you a Defendant in Any Suits or Legal Actions?                                                       On Leases or Contracts
                                 YES                                      NO                                                    YES                                          NO
Date Income Taxes were last filed?                                                                       Legal Claims
                                                                                                                                YES                                          NO
Have you ever been declared Bankrupt in the last 10 years?                                               Federal - State Income Taxes
                                 YES                                      NO                                                    YES                                          NO
Are you a Partner or Officer in any other Venture?                                                       Other
                                 YES                                      NO
                                                                                                     SCHEDULES
A CASH IN BANKS AND NOTES DUE TO BANKS                                          (List all Real Estate Loans in Sched E)
        NAME OF BANK           Type of Acct                 Type of Ownership         On Deposit              Notes Due to Bank                             Collateral (if Any) and Type of Ownership
                                                                                $                -


                                                                                                          $                   -
                                                                                $                -        $                   -
                                                                        $                        -        $                   -
                                                           Cash On Hand $                        -        $                   -
                                                                  TOTALS $                       -        $                   -
B       LIFE INSURANCE (List only those Policies that you own)
                                                                                                                        Policy Loan From    Other Loans Policy as
                COMPANY                       FACE OF POLICY                       Cash Surrender Value                  Insurance Co.            Collateral                                        BENEFICIARY




                                          $                   -     $                                             -    $             -
                                          $                   -     $                                             -    $             -
                                       TOTALS $                                 -   $                                                -
C       SECURITIES OWNED (Including U.S. Government Bonds and all other Stocks and Bonds)
                                                                                                                       Market Value - US        Market Value -      Market Value - Non
    Face Value Bonds, # Shares of Stock        DESCRIPTION               Type of Ownership                COST             Gov Sec              Marketable Sec          Mkt Sec                      Amount Pledged To Secured Loan




                                                                                                  $               -    $             -      $                  -    $                -
                                                                                                  $               -    $             -      $                  -    $                -
                                                                                                  $               -    $             -      $                  -    $                -
                                                                                                           TOTALS      $             -      $                  -    $                -
D       NOTES AND ACCOUNTS RECEIVABLE (Money Payable or Owed to You Individually - Indicate % of your Ownership Interest)
                                                                                                                          Balance Due       Balance Due Over 90     Balance Due Notes Rel.
               MAKER/DEBTOR                            %                     When Due                 Original Amt      Current Accounts           Days                   & Friends                          Security (If Any)
                                                      100                                                              $             -      $                  -    $                -
                                                                                                                       $             -      $                  -    $                -
                                                                                                                       $             -      $                  -    $                -
                                                                                                                       $             -      $                  -    $                -
                                                                                                                       $             -      $                  -    $                -
E      REAL ESTATE OWNED (Indicate % of your Ownership Interest)
            TITLE IN NAME OF              %         Date                Description & Location        Original Cost     Present Value of                                    MORTGAGE OR CONTRACT PAYABLE
                                                   Acquired                                                               Real Estate            Balance Due            Mo. Payment                    Maturity




                                                                                                                                                                    $                -


                                                                                                                                                                    $                -
                                                                     TOTALS $           -                                                   $                  -
F      MORTGAGES AND CONTRACTS OWNED (Indicate % of your Ownership Interest)
                                        MAKER                    Property
        Mortgage or Contract %      Name & Address               Covered     Starting Date                                                       Payments                Maturity                            Balance Due


                                                                                                                                                                                             $                                        -
                                                                                                                                                                                             $                                        -
                                                                                                                                                                                             $                                        -
                                                                                                                                                                             TOTALS $                                                 -
G       PERSONAL PROPERTY (Indicate % of your Ownership Interest)
                                                                                                                           Cost When                Value                                        LOAN ON PROPERTY
                          DESCRIPTION                                      Date When New                   %                  New                   Today               Balance Due                        To Whom Payable




                                                                                                                                            $                  -    $                -
                                                                                                                                            $                  -    $                -
                                                                                                                              TOTALS $                         -    $               -
H      NOTES
                                                                        Notes Due To Rel. and     Notes Due "Others"
              PAYABLE TO                  Other Obligors (If any)              Friends               (Not Banks)       Accounts and Bills     Contracts Payable         COLLATERAL                             When Due
                                                                                                  $               -    $             -      $                  -
                                                                    $                        -    $               -    $             -      $                  -
                                                                    $                        -    $               -    $             -      $                  -
                                                     TOTALS $                                -    $              -     $            -       $                -


The above financial statement is the most recent financial statement prepared by or for me. I understand that Premier Bank is relying on the information in this financial statement in deciding to give or continue the
financial accomodation or extension of credit requested or received. These statements are delivered to Premier Bank to induce it to extend credit from time to time and/or continue its present extensions of credit, at its
discretion, to the undersigned. The undersigned hereby certifies that these statements are correct and completed. and accurately reflect the condition and affairs of the undersigned at the date and for the period(s) stated
and that said statements reflect all known liabilities, direct or contigent, as of date thereof.



The undersigned also represents and warrants that to his/her knowledge there has to date been no material adverse change in the conditions or affairs of undersigned from dated of said statements.

The undersigned does hereby request and warrant that legal title to all property herein described or referred to excepting only jointly owned property as separately scheduled herein as such, is in the sole name of the
undersigned. Every person who is a party to this statement agrees that his/her separate property listed herein or herein referred to and property or interest in property into which property listed herein or herein referred to
is converted or re-converted, including his/her interest in property owned jointly by entirely or in common with another party to this statement, shall be available to the bank for payment of all indebtedness or other
obligations of the parties making this statement, or either of them voluntary or involuntary by levy of execution or otherwise.
Premier Bank is authorized to make all inquiries deemed necessary to verify the accuracy of the information contained herein, and to determine the creditworthiness of the undersigned. Each of the undersigned
authorizes the Bank to answer questions about its credit experience with the undersigned.
I have read, understand and agree to make these representations and warranties

If an individual statement                                                                                             If a joint statement

Signature                                                                                                              Spouse Signature
                                      Date:                                                                                                                 Date:
Attachment to Financial Statement of (name)
Schedule of Rental Property Income and Debt
As of (date)


                                              Monthly    Lease     Monthly
            Property Address                   Rent     Maturity    Debt     PITI   Lender

				
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