PERSONAL BALANCE SHEET

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					        Confidential                               PERSONAL BALANCE SHEET                                                  Cover Page



                                                       INDIVIDUAL INFORMATION
[ #1 ] Individual Name                                                    Social Security # (s)                      Date of Birth



              Physical Address:                                                                                       Phone # (s)

               City, State & Zip:                                                                                                       (Home)
                                                                                                                                        (Work)
                Billing Address:                                                                                                        (Cell)

               City, State & Zip:                                                                                                       (Fax)

                            Email Address:
       Driver's License #                        State Issued                  Date Issued                          Expiration Date
                                                                                  /               /                    /        /

[ #2 ] Individual Name (Spouse)                                           Social Security # (s)                      Date of Birth



              Physical Address:                                                                                       Phone # (s)

               City, State & Zip:                                                                                                       (Home)
                                                                                                                                        (Work)
                Billing Address:                                                                                                        (Cell)

               City, State & Zip:                                                                                                       (Fax)

                            Email Address:

       Driver's License #                        State Issued                  Date Issued                          Expiration Date
                                                                                  /               /                    /        /

 The information contained in this statement is provided for the purpose of obtaining, or maintaining credit with San Luis Valley Federal
 Bank on behalf of the undersigned, or persons, organizations or corporations in whose behalf the undersigned may either severally or
 jointly with others, execute a guaranty in San Luis Valley Federal Bank's favor. Each undersigned understands that San Luis Valley
 Federal Bank is relying on the information provided herein (including the designation made as to ownership of property) in deciding to
 grant or continue credit. Each undersigned represents and warrants that the information provided to San Luis Valley Federal Bank as
 part of this application is true and complete, including, but not limited to all financial statements, tax returns, balance sheets and profit &
 loss statements. San Luis Valley Federal Bank may consider this statement as continuing to be true and correct until a written notice of
 a change is given to San Luis Valley Federal Bank by the undersigned. San Luis Valley Bank is authorized to make all inquiries it
 deems necessary to verify the accuracy of the statements made herein, and to determine my/our creditworthiness now or in the future.
 San Luis Valley Federal Bank is authorized to provide requested information about its credit experience with me/us. My signature
 below is as an individual and as proper representative of the organizations or corporations (if applicable).




Signature                                                                                             Date




Signature                                                                                             Date

                                                  SAN LUIS VALLEY FEDERAL BANK
Confidential   PERSONAL BALANCE SHEET   Cover Page
           Confidential                                PERSONAL BALANCE SHEET                                        Totals

            Current Assets                                   Value            Current Liabilities                       $ Owed

Cash & Equivalents                            Sch. 1                  Taxes Payable                       Sch. 9
Accounts & Notes Receivable                   Sch. 2                  Short Term Liabilities              Sch. 10
Furniture & Other Pers. Property              Sch. 3
Stocks & Bonds                                Sch. 4
Retirement Accounts                           Sch. 5


                               CURRENT ASSETS                                                  CURRENT LIABILITIES

       Intermediate Assets                                                 Intermediate Liabilities

Vehicles                                      Sch. 6                  Mid (Intermediate) Liabilities      Sch. 10
Other Assets                                  Sch. 7


                           INTERMEDIATE ASSETS                                        INTERMEDIATE LIABILITIES

        Long Term Assets                                                    Long Term Liabilities

Real Estate & Land                            Sch. 8                  Long Term Liabilities               Sch. 10


                             LONG TERM ASSETS                                             LONG TERM LIABILITIES

                                   TOTAL ASSETS                                                  TOTAL LIABILITIES
                                                                            NET WORTH (Assets less Liabilities)

                                                                              TOTAL LIABILITIES & NET WORTH

                                                       SAN LUIS VALLEY FEDERAL BANK




        __________            __________
        Officer Initials      Date Received                                                                          Page 2
     Confidential                                       PERSONAL BALANCE SHEET                                                    Schedules 1 - 5


                                                                                                                                  (Omit Cents)
Sch. 1 - Cash & Equivalents
Type of Account (Cash / CD / Checking / Savings)                              Bank                                                  Value




                                                                                                                       TOTAL
                                                                                                                                  (Omit Cents)
Sch. 2 - Accounts & Notes Receivable
Description (Attached A/R schedule, or other lists, as necessary)             Name on A/R or Note                                   Value




                                                                                                                       TOTAL
                                                                                                                                  (Omit Cents)
Sch. 3 - Furniture & Other Personal Property
Description (Attach list as necessary)                                                                                              Value
                                                                    Note:
                                                                    You do not need to list each piece of furniture.
                                                                    List more expensive items individually, then group
                                                                    other items with an estimated total value.




                                                                                                                       TOTAL
                                                                                                                                  (Omit Cents)
Sch. 4 - Stocks and Bonds
Description (Attach list as necessary)                                                                                              Value




                                                                                                                       TOTAL
                                                                                                                                  (Omit Cents)
Sch. 5 - Retirement Accounts
Type of Account (IRAs, PERA, 401k, etc.)                               Bank / Company                                               Value




                                                                                                                          TOTAL

                                                  SAN LUIS VALLEY FEDERAL BANK



                                                                                                                                                 Page 3
          Confidential                                   PERSONAL BALANCE SHEET                               Schedules 6 - 9



                                                                                                                  (Omit Cents)
Sch. 6 - Vehicles (Include Motorcycles, Boats, etc.)
Description: Make | Model | Year | Miles | (Attach list as necessary)                                               Value




                                                                                                          TOTAL
                                                                                                                  (Omit Cents)
Sch. 7 - Other Assets
Description (Attach list as necessary)                                                                              Value




Cash Value of Life Insurance (From Sch. 13)
                                                                                                          TOTAL
                                                                                                                  (Omit Cents)
Sch. 8 - Real Estate & Land
Legal Desc. &/or physical address                                Type of Property   Yr. Acquired   Cost             Value




                                                                                                          TOTAL
Sch. 9 - Taxes Payable                                                                                            (Omit Cents)
Description                                                                         When Due                       $ Owed




                                                                                                          TOTAL

                                                  SAN LUIS VALLEY FEDERAL BANK


                                                                                                                         Page 4
           Confidential                                                               PERSONAL BALANCE SHEET                                                                              Schedule 10


                                                                                                                                                                           (Omit Cents)     (Omit Cents)
Sch. 10 - Debt Schedule
                                                                        Purpose & Collateral (Be specific)                                                                 TOTAL           Principal &
                                                           Example: [Purchase R/E - Comm'l Building at 229 Morris Alamosa]       Int.        Payment            Maturity   Principal         Interest
    Type         Bank or Creditor       Account #            Example: [Purchase Auto - 1999 GMC PU / Crew Cab / 4X4]             Rate         Date               Date      Balance          Payment
Short Term Liabilities Include Credit Cards, Operating Lines of Credit and / or Current Portion of Mid (Intermediate) Term and Long Term Debt
  Short Term
  Short Term
  Short Term
  Short Term
  Short Term
  Short Term
  Short Term
                                                                                                                                TOTAL - Short Term (To Main Page)
Mid (Intermediate) Term debt includes Vehicle Loan(s), Equipment Loan(s) and / or other debts with an amortization of less than 7 years (not including real estate).
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
  Mid Term
                                                                                                                                  TOTAL - Mid Term (To Main Page)
Long Term debt includes Home Mortgage and Real Estate Purchases
  Long Term
  Long Term
  Long Term
  Long Term
  Long Term
  Long Term

                                                                                                                                TOTAL - Long Term (To Main Page)

                                                                                 SAN LUIS VALLEY FEDERAL BANK


                                                                                                                                                                                                  Page 5
          Confidential                                PERSONAL BALANCE SHEET                                                      Schedules 11-13


Sch. 11 - Current Income Sources (Attach pay stubs and statements as available)
(Salary, bonuses, commissions, dividends, R/E income, etc.)       Source                                                                    Income




                                                                                                                            TOTAL
Note: If one source of income stated above is rental property, you must complete the rent roll that is included in this packet.

Sch. 12 - Contingent Liabilities
Description (co-maker, guarantor, legal claims, tax liens, etc.)              Other Information (Names/banks/etc.)                          $ Owed




                                                                                                                            TOTAL
Sch. 13 - Life Insurance Carried                                                                                                          Cash Surrender
Name of Insurance Company                                          Owner of Policy                Beneficiary             Face Amount        Value




                                                                                                             TOTAL

                                                    SAN LUIS VALLEY FEDERAL BANK




                                                                                                                                            Page 6

				
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