Personal Financial Statement PERSONAL FINANCIAL

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					                                                                                                                   PERSONAL FINANCIAL
                                                                                                                       STATEMENT

APPLICANT            PLEASE TYPE OR PRINT CLEARLY. ANSWER ALL ITEMS. IF “NONE” SO STATE.
NAME OF BORROWER      (LAST, FIRST, MIDDLE)                                                                            SOCIAL SECURITY NUMBER


STREET ADDRESS                                                                                     CITY                                         STATE               ZIP


HOME PHONE                                           WORK PHONE                                    EMAIL ADDRESS                                        DATE OF BIRTH


EMPLOYER                                                                POSITION                                       YRS THERE                        ANNUAL INCOME


EMPLOYER STREET ADDRESS                                                                            CITY                                         STATE               ZIP


SUPERVISOR                                                              PHONE                                          WORK EMAIL ADDRESS


EMPLOYER (IF CURRENT IS LESS THAN 2 YEARS)                              POSITION                                       YRS THERE                        ANNUAL INCOME


EMPLOYER STREET ADDRESS                                                                            CITY                                         STATE               ZIP


SUPERVISOR                                                              PHONE                                          WORK EMAIL ADDRESS



CO-APPLICANT                P LEASE TYPE OR PRINT CLEARLY. ANSWER ALL ITEMS. IF “NONE” SO STATE.
NAME OF BORROWER      (LAST, FIRST, MIDDLE)                                                                            SOCIAL SECURITY NUMBER


STREET ADDRESS                                                                                     CITY                                         STATE               ZIP


HOME PHONE                                           WORK PHONE                                    EMAIL ADDRESS                                        DATE OF BIRTH


EMPLOYER                                                                POSITION                                       YRS THERE                        ANNUAL INCOME


EMPLOYER STREET ADDRESS                                                                            CITY                                         STATE               ZIP


SUPERVISOR                                                              PHONE                                          WORK EMAIL ADDRESS


EMPLOYER (IF CURRENT IS LESS THAN 2 YEARS)                              POSITION                                       YRS THERE                        ANNUAL INCOME


EMPLOYER STREET ADDRESS                                                                            CITY                                         STATE               ZIP


SUPERVISOR                                                              PHONE                                          WORK EMAIL ADDRESS



BALANCE SHEET
Assets                                                                                             Liabilities
1. Cash (Schedule A)                                                         $                     16. Loans Payable to Bank – Unsecured (Schedule I)               $
2.   Marketable Securities (Schedule B)                                                            17. Loans Payable to Bank – Secured (Schedule I)
3.   Accounts & Notes Receivable (Schedule C)                                                      18. Loans Payable to Others
4.   Cash Surrender Value – Life Insurance (Schedule                                               19. Mortgage Payable (Schedule J)
D)
5.   Real Estate Owned – Market Value (Schedule E)                                                 20. Installment Contracts Payable
6.   Mortgage Owned (Schedule F)                                                                   21. Federal & State Income Taxes Payable
7.   Business Interests – Market Value (Schedule G)                                                22. Other Taxes & Interest Payable
8.   Business Investments – Cost (Schedule H)                                                      23. Loans Against Cash Surrender Value – Life Ins.
9.   Pensions, IRA, 401K, Keogh                                                                    24. Other Liabilities (Schedule K)
10. Other Assets (Describe):                                                                       25. Other (Describe):
11. Other Assets (Describe):                                                                       26. Other (Describe):
12. Other Assets (Describe):                                                                       27. Other (Describe):
13. Other Assets (Describe):                                                                       28. TOTAL LIABILITIES                                            $
14. Other Assets (Describe):                                                                       29. NET WORTH                                                    $
15. TOTAL ASSETS                                                             $                     30. TOTAL LIABILITIES & NET WORTH                                $

                                                                                                                                                                          1
  REMINDER – IF NOT COMPLETED JOIN TLY, LIST ONLY YOUR PROPORTIONATE INTEREST IN ANY JOIN TLY HELD ASSETS & LIABILITIES.

SCHEDULE A – CASH BA LANCES
                                          ACCOUNT TYPE                                                       PLEDGED?
 NAME AND LOCATION OF DEPOSITORY       & ACCOUNT NUMBER                      ACCOUNT SIGNORS                    Y/N       CASH BALANCE
                                                                                                                          $




                                                                                                   TOTAL CASH BALANCES    $


SCHEDULE B – MARKETABLE SECURITIES
                                                                                                             PLEDGED?
  NAME/DESCRIPTION OF SECURITIES       NUMBER OF SHARES                    REGISTERED OWNER(S)                  Y/N       MARKET VALUE
                                                                                                                          $




                                                                                                    TOTAL MARKET VALUE    $


SCHEDULE C – ACCOUNTS & NOTES RECEIVABLE
                                                     INTEREST     MATURITY                                    ANNUAL          REMAINING
           DUE FROM                ORIGINAL AMOUNT     RATE        DATE               COLLATERAL             PAYMENT           BALANCE
                                                                                                                          $




                                                                                            TOTAL RECEIVABLES BALANCE     $


SCHEDULE D – LIFE INSURANCE
                                                                        FACE                                   PLEDGED?
   INSURANCE COMPANY NAME          POLICY NUMBER          OWNER        AMOUNT               BENEFICIARY           Y/N     NET CASH VALUE
                                                                       $                                                  $


                                                                                                   TOTAL NET CASH VALUE   $


SCHEDULE E – REA L ESTATE OW NED
                                           DATE                                                              MORTGAGED?
           LOCATION & TYPE               ACQUIRED    % OWNED               COST          NET RENTAL INCOME      Y/N       MARKET VALUE
                                                                   $                    $                                 $




                                                                                                    TOTAL MARKET VALUE    $


                                                                                                                                          2
SCHEDULE F – MORTGA GES OWNED
                                                                                     ANNUAL         MATURITY           ASSIGNED?       REMAINING
      LOCATION/TYPE OF PROPERTY                     MORTGAGOR                        INCOME          DATE                 Y/N           BALANCE
                                                                                 $                                                 $


                                                                                 TOTAL MORTGAGES OWNED BALANCE                     $


SCHEDULE G – BUSINESS INTERESTS
                                                                                                ANNUAL             ANNUAL NET
         NAME & BUSINESS TYPE           DATE ACQUIRED     % OWNED           COST                REVENUE              INCOME        MARKET VALUE
                                                                      $                   $                    $                   $




                                                                                                   TOTAL MARKET VALUE              $


SCHEDULE H – BUSINESS INVESTMENTS
                                                                                                  CASH DISTRIBUTIONS
         NAME & BUSINESS TYPE           DATE ACQUIRED     % OWNED           COST              PRIOR YEAR      CURRENT YEAR             NET EQUITY
                                                                      $                   $                    $                   $




                                                                                                      TOTAL NET EQUITY             $


SCHEDULE I – LOANS PAYABLE
                                         ORIGINAL                                    INTEREST      MATURITY            MONTHLY         CURRENT
      NAME &LOCATION OF LENDER           AMOUNT         COLLATERAL DESCRIPTION         RATE         DATE               PAYMENT         BALANCE
                                    $                                                                              $               $




                                                                                                  TOTAL LOAN BALANCES              $


SCHEDULE J – MORTGAGES PA YABLE
                                         ORIGINAL                                    INTEREST      MATURITY            MONTHLY         CURRENT
      NAME &LOCATION OF LENDER           AMOUNT          COLLATERAL ADDRESS            RATE         DATE               PAYMENT         BALANCE
                                    $                                                                              $               $




                                                                                         TOTAL MORTGAGE BALANCES                   $




                                                                                                                                                    3
SCHEDULE K – O THER LIABILITIES
                                                         ORIGINAL                                            INTEREST         MATURITY        MONTHLY           CURRENT
                    OWED TO                              AMOUNT                    COLLATERAL                  RATE            DATE           PAYMENT           BALANCE
                                                     $                                                                                    $                 $




                                                                                                                        TOTAL OTHER LIABIL ITIES            $


INCOME & EXPENSES
            INCOME                              Applicant             Co-Applicant                   EXPENSES                             Applicant          Co-Applicant
Salary                                      $                     $                      Personal Living Expenses                     $                     $
Interest/Dividends                                                                       Loans Payable
Rental Income                                                                            Mortgages Payable
Business Income                                                                          Business Contributions
Capital Gains                                                                            Taxes
Other Income                                                                             Other Expenses
TOTAL INCOME                                $                     $                      TOTAL EXPEN SES                              $                     $


             DESCRIBE SOURCE OF OTHER INCOME ABOVE                                                           DESCRIBE OTHER EXPENSES ABOV E




Have any judgments been entered against you?                                                                             YES                    NO
If so, please describe:

Have you ever filed bankruptcy?                                                                                          YES                    NO
If so, when and where:

The information contained in this statement is provided for the purpose of obtaining or maintaining credit with you on my/our behalf or on the behalf of persons, firms, or
corporations in whose behalf I/we may, either severally or jointly with others, execute a guaranty in your favor. I/we understand that you are relying on this information
(including the designation made as to ownership of property) in deciding to grant or continue credit. I/we represent and warrant that the information provided is true and
complete and that you may consider this statement as continuing to be true and correct until a written notice of change is gi ven to you by me/us. I/we agree to notify you
promptly of any such change. You are authorized to check the statements made on this form, run credit reports from any repor ting agency, and to determine my/our
creditworthiness. You will tell me/us upon request whether or not a consumer report was requested and, if so, inform me/us of the name and address of the consumer
reporting agency. You are authorized to answer questions about your credit experience with me/us. You may order additional consumer reports and otherwise check my/our
credit at any time while credit is outstanding in conjunction with an update, renewal, refinance, or extension of such credit or in connection with collection efforts. You may
retain this statement whether or not credit is approved.



Applicant                                                                                  Co-Applicant
                  Signature                                                                                       Signature

       Date                                                                                            Date



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