Lease Application Personal Financial Statement by imakyottiefosho

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									Lease Application / Personal Financial Statement
(Fill in all blanks. Write “No” or “None” where necessary to complete information)




Subject Property
Name of Property you are interested in:

Description/Address of Property:




Personal Information
Full Legal Name of Applicant:                                                                                       Male:       Female:
                                            First Name        Middle Initial      Last Name




Applicant’s Date of Birth:                               Social Security Number:                                    Applicant’s Drivers License No.:



Full Legal Name of Spouse:                                                                                          Male:       Female:
                                            First Name        Middle Initial      Last Name




Spouse’s Date of Birth:                                  Social Security Number:                                    Spouse’s Drivers License No.:

Present Home Address:                                                                                               Home Telephone:
                                            Street Address      City      State     Zip Code


Prior Home Address:
                                            Street Address      City      State     Zip Code




Applicant’s Current Employer:                                                                                       Telephone:

Address:
                                            Street Address      City      State     Zip Code




Position Held:                                           Number of Years:                      Applicant’s Previous Employer:



Spouse’s Employer:                                                                                                  Telephone:

Address:
                                            Street Address      City      State     Zip Code




Position Held:                                               Number of Years:




r   Married          r    Single      r   Divorced              r      Widowed



Ages: Self:           Spouse:          Children:
Personal Financial Statement
The following is a true and accurate statement of the financial condition of the undersigned on                                       , 20


Source of Annual Income                                                   Liabilities
Base Salary                                 $                             Mortgages Payable on Real Estate (see Sched. 5)             $

Spouse’s Salary                             $                             Notes Payable: To Banks and Savings & Loans                 $

Business of Professional Income (net)       $                                                 To Relatives or Others                  $

Dividends and Interest Income               $                             Installment Accts Payable: Automobile                       $

Real Estate Cash Flow (net)                 $                                                            Other                        $

Other Income – Itemize                      $                             Unpaid Real Estate Taxes                                    $
                                            $
                                            $                             Unpaid Income Taxes                                         $

TOTAL ANNUAL INCOME                         $                             Unpaid Chattel Mortgages                                    $

                                                                          Personal Property Mortgages                                 $

Assets                                                                    Loans on Life Insurance Policies (Incl. Premium Advances)   $

Cash in Banks, Savings, Loans (see Sched. 1) $                            Other Debts – Itemize:                                      $
                                                                                                                                      $
Investments: Stocks & Bonds (see Sched. 2) $                                                                                          $
                                                                                                                                      $
Investment in Own Business (attach P&L)     $                                                                                         $

Investments in Other Businesses             $
Acts & Notes Receivable (see Sched. 3)      $                             Total Liabilities                                           $

Real Estate Owned (see Sched. 4)            $                             Net Worth                                                   $

Automobiles:                                                              TOTAL LIABILITIES AND NET WORTH                             $
Year      Make                              $
Year      Make                              $
Year      Make                              $                             Contingent Liabilities
Year      Make                              $
                                                                          As Endorser or Co-maker on Notes                        $
Personal Property and Furniture             $                             As Guarantor                                            $
                                                                          Alimony, Child Support or Separate Maintenance Payments $
Life Insurance                              $                                                                                     (Annual)

Cash Surrender Value                        $

Other Assets – Itemize                      $
                                            $
                                            $



TOTAL ASSETS                                $
Personal Financial Statement
Schedule 1 – Cash: Bank/Savings & Loan Accounts
                         Cash Balance              Name of
Pers         Coml        As Above Date             Bank/Savings & Loan                                 Acct. No.

r            r           $

r            r           $

r            r           $

r            r           $

r            r           $

r            r           $



Schedule 2 – Readily Marketable Securities & Other Investments
                                                                                               Listed Securities              Unlisted Securities
No. of Shares         Where                                       Issued in                    Market Value Now               Value Now
Or Bond Amounts       Listed             Description              Whose Name                   Price Ea. / Total Price Ea.:   Total / Pledged to:




Total:



Schedule 3 – Accounts Receivable: Trust Deeds & Mortgages Owned
Name                  Street Address                   Original          Unpaid                                    Monthly    1st/2nd        Value of
of Payor              of Property                      Amount            Balance          How Held                 Payment    Lien           Property




Total:



Schedule 4 – Real Estate Owned
Assessor’s          Street Address                 Title in                        Monthly Net               Purchase Price             Valuation
Parcel No.          Type of Property               Name of                         Income Produced           Date / Amount              Today




Total:



Schedule 5 – Mortgages on Real Estate
Assessor’s
Parcel No.          Payable To                     Monthly Payments                Maturity Date             Unpaid Loan                Balance




Total:
Other Information
Are you a defendant in any legal action?                                     If yes, please give details:
r yes r no

Are you a guarantor, co-maker or endorser of anyone’s debt?                  If yes, please give details:
r yes r no

Are there any unpaid judgements against you?                                 If yes, please give details:
r yes r no

Have your income tax returns ever been questioned by any                     If yes, please give details:
governmental authority? r yes r no

Are there any assets encumbered or debts secured other than                  If yes, please give details:
as indicated? r yes r no

Have you ever applied for or obtained credit under another name?             If yes, please give details:
r yes r no

Have you ever filed for bankruptcy or compromised a debt during              If yes, please give details:
the past 14 years? r yes r no

Are you a U.S. citizen? r yes r no

Have you prepared a business plan and/or cash flow projection for            If yes, please give details:
your business? r yes r no

Please state your business and intended use:                                 Do you have any other business interests?



Are you a partner or officer in any other business venture?                  If yes, please give details:
r yes r no

List the name and phone numbers of landlord, bank, business & credit references:




Are there any other factors you consider important for the landlord to consider in evaluating your business history, creditworthiness or suitability for the
referenced premises? r yes r no                                           If yes, please give details:




The undersigned, for the purpose of procuring a lease from Landlord, warrants the above (along with any attached schedule) to constitute a full, true and correct
statement of the financial condition of the undersigned on the date shown below. Undersigned, if this statement is in his/her name only, affirms that none of the
assets listed above are separate property of his/her spouse, if any, and that if community property is listed, all liabilities of the community are also listed. Undersigned
agrees to notify Landlord immediately of the extent and character of any material adverse change in financial condition. I authorize the Landlord to check my credit
references, to contact any consumer or business credit reporting agency, to verify my employment or to substantiate any of the information contained herein from
whatever source it deems appropriate and hereby authorize the banks and other credit sources named above to release any information request to the Landlord.

This Personal Financial Statement is furnished for the purpose of inducing landlord to execute a lease agreement; I understand there are penalties under the law for
knowingly making any false statements, or making a willful over-evaluation my personal financial condition for the purpose of influencing in any way Landlord’s
evaluation of my rental applications.

Dated:                                       Applicant:



Dated:                                       Spouse of Applicant:

Please send Lease Application / Personal Financial Statement via facsimile to 408 762.2028 or mail to:

Smith-Wagle Commercial Management, Inc.
17500 Depot Street, Suite 170,
Morgan Hill, CA 95037

								
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