Spreadsheet: 19b20ab1-9bc5-4a82-81b0-45c8b45923ea
Sheet: PFS

 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TO: NVB (Lender)
Name:
Mailing Address:
You may apply for credit in your name alone, regardless of your marital status.
CHECK AS APPLICABLE:  [NAME] is applying for this loan:
 |  |  |  | Individually, without a co-signer or guaranty of a relative or other person(s) or entity.
 |  |  |  | Jointly, with the co-signature or guaranty of one or more persons or entities (including any existing guarantors).
Names of Other Person(s) and Entity(ies):
PLEASE INDICATE OR PROVIDE EXPLANATION RELATING TO ANY ASSETS OWNED JOINTLY OR BY A TRUST OR LIABILITIES OWNED WITH OTHERS.
([NAME] AND EXPLANATORY NOTES IF NECESSARY.)
If applicant resides in a community property state, please complete the following concerning marital status:
Applicant is:                                Married              Unmarried (Includes single, divorced or widowed)                 Separated
Co-Applicant, if any, is:               Married              Unmarried (Includes single, divorced or widowed)                 Separated
STATEMENT OF FINANCIAL CONDITION OF |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AS OF
 |  |  |  |  |  |  |  |  |  |  | Name(s) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
AMOUNTS AUTOMATICALLY FILL IN FROM ATTACHED SCHEDULES.  THE BLUE LINES REQUIRE INPUT, AS APPLICABLE.
ASSETS |  |  |  |  |  |  |  |  |  |  |  | AMOUNTS |  |  |  |  | LIABILITIES |  |  |  |  |  |  |  |  |  |  |  |  | AMOUNT
CASH |  |  | SCHEDULE A |  |  |  |  |  |  |  |  |  |  |  |  |  | NOTES & LOANS PAYABLE (Other Than Real Estate) |  |  |  |  |  | SCHEDULE G
 |  |  | In this Institution |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Notes Payable to Banks
 |  |  | Other Banks or S&L |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Notes Payable Other
 |  |  | Investment Firms |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other: |  |  |  |  |  |  |  | 0
STOCKS & BONDS |  |  | SCHEDULE B |  |  |  |  |  |  |  |  |  |  |  |  |  | REVOLVING ACCOUNTS PAYABLE |  |  |  |  |  | SCHEDULE H
 |  |  | Marketable Securities |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bank Charge Cards
 |  |  | 401K Retirement Accounts |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Department Store Accounts
 |  |  | Other: |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | Other: |  |  |  |  |  |  |  | 0
TAXES |  |  | Tax Refund Due |  |  |  |  |  |  |  |  | 0 |  |  |  |  | TAXES |  |  |  |  |  | Taxes Owed |  |  |  |  |  |  |  | 0
INSURANCE |  |  | SCHEDULE C |  |  |  |  |  |  |  |  |  |  |  |  |  | INSURANCE |  |  |  |  |  | SCHEDULE C
 |  |  | Cash Value Life Insurance |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Loans on Life Insurance
ACCOUNTS & NOTES RECEIVABLE |  |  | SCHEDULE D |  |  |  |  |  |  |  |  |  |  |  |  |  | BILLS PAYABLE |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
REAL ESTATE |  |  | SCHEDULE E |  |  |  |  |  |  |  |  |  |  |  |  |  | REAL ESTATE LIABILITIES |  |  |  |  |  | SCHEDULE E
 |  |  | Residence(s) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Residence(s)
 |  |  | Unimproved Land |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Unimproved Land
 |  |  | Income Property(ies) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Income Property(ies)
 |  |  | Other: |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | Other: |  |  |  |  |  |  |  | 0
OTHER ASSETS |  |  | SCHEDULE F |  |  |  |  |  |  |  |  |  |  |  |  |  | OTHER             LIABILITIES |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  | Personal Property |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
TOTAL ASSETS |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL LIABILITIES
NET WORTH (DIFFERENCE BETWEEN TOTAL ASSETS & TOTAL LIABILITIES)
* OTHER INCOME: Alimony, child support or maintenance payment income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
ANNUAL INCOME FOR YEAR |  |  |  |  |  |  |  |  |  |  | ANNUAL EXPENSES FOR YEAR |  |  |  |  |  |  |  |  |  |  |  |  | CONTINGENT LIABILITIES
[NAME] or Wages |  |  |  |  |  | 0 |  |  |  |  | Real Estate Loan Payments |  |  |  |  |  |  |  | 0 |  |  |  |  | As Guarantor on Notes/Contracts |  |  |  |  |  |  |  |  | 0
Dividends or Interest |  |  |  |  |  | 0 |  |  |  |  | Payments on Contracts/Notes |  |  |  |  |  |  |  | 0 |  |  |  |  | For Taxes |  |  |  |  |  |  |  |  | 0
Rentals (Gross Income) |  |  |  |  |  | 0 |  |  |  |  | Payments on Bankcard |  |  |  |  |  |  |  | 0 |  |  |  |  | Other (Describe) |  |  |  |  |  |  |  |  | 0
Business (Net Income) |  |  |  |  |  | 0 |  |  |  |  | Property Tax & Assessments |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Other Income (Describe)* |  |  |  |  |  | 0 |  |  |  |  | Federal & State Income Tax |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  | 0 |  |  |  |  | Estimated Living Expenses |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  | 0 |  |  |  |  | Other: |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
TOTAL INCOME |  |  |  |  |  |  |  |  |  |  | TOTAL EXPENSES |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL CONTINGENT LIABILITIES
If insufficient room available for any schedule below, please provide separate details and input total of values below.
SCHEDULE A |  |  |  |  | CASH LOCATION AND STATUS OF BANK ACCOUNTS
INSTITUTION |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |  | CK | SA | CD | INV | Account # |  |  |  |  |  |  | Balance
North Valley Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
North Valley Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
OTHER BANKS |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |  | CK | SA | CD | INV | Account # |  |  |  |  |  |  | Balance
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
INVESTMENT FIRMS |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |  | CK | SA | CD | INV | Account # |  |  |  |  |  |  | Balance
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
SCHEDULE B |  |  |  |  | STOCKS AND BONDS  (Include Interest in any Closely Held Business)
Stocks Description |  |  |  |  |  |  | No. Shares |  | Registered in Name of |  |  |  |  |  | Source of Valuation |  |  |  | Date |  |  |  | Price Per Share |  |  | Pledged or Purchased on Margin |  |  |  | Total Value
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
401K Retirement
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
SCHEDULE C |  |  |  |  | LIFE INSURANCE POLICIES AND LOANS
Insured |  |  |  |  |  |  | Primary Beneficiary |  |  |  |  |  | Company Name |  |  |  |  |  |  | Face Value |  |  | Cash Value |  |  | Loan on Policy |  |  |  | Repayment Terms
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  | 0 |  |  | 0
TOTAL
SCHEDULE D |  |  |  |  | ACCOUNTS AND NOTES RECEIVABLE
Due From |  |  |  |  |  |  |  |  | Collateral |  |  |  |  |  | Maturity Date |  |  |  |  | Repayment Terms |  |  |  |  |  |  |  |  |  | Balance Due
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  | Per |  |  |  |  |  | 0
TOTAL
SCHEDULE E |  |  |  |  | REAL ESTATE
ADDRESS |  |  |  |  |  |  | Property Type |  |  | Date Acquired |  |  | Present Value |  |  | Mortgage Holder |  |  |  |  |  |  |  | Monthly Income |  | Monthly Payments |  |  | Annual Taxes & Insurance |  |  | Loan                     Balance
RESIDENCE
 |  |  |  |  |  |  | SFR |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
TOTALS
UNIMPROVED LAND
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
TOTALS
INCOME PROPERTY
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0 |  | 0 |  |  | 0 |  |  | 0
TOTALS
Property Types: SFR, Condo, Acres, Lots, Commercial
SCHEDULE F |  |  |  |  | OTHER ASSETS AND PERSONAL PROPERTY
Description |  |  | Value |  |  |  | Description |  |  | Value |  |  |  | Description |  |  | Value |  |  |  |  | Description |  |  |  |  |  |  |  |  |  | Value
Automobiles |  |  | 0 |  |  |  | Furniture |  |  | 0 |  |  |  | Art Work |  |  | 0 |  |  |  |  | Other: |  |  |  |  |  |  |  |  |  | 0
RV & Boats |  |  | 0 |  |  |  | Jewelry |  |  | 0 |  |  |  | Equipment |  |  | 0 |  |  |  |  | Other: |  |  |  |  |  |  |  |  |  | 0
TOTAL
SCHEDULE G |  |  |  |  | NOTES AND LOANS PAYABLE TO BANKS AND OTHERS
Payable to Banks |  |  |  |  |  |  | Collateral |  |  |  |  |  |  | Person Liable |  |  |  |  | Maturity Date |  |  |  |  | How Payable |  |  |  |  |  |  |  | Balance Due
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
Payable to Others |  |  |  |  |  |  | Collateral |  |  |  |  |  |  | Person Liable |  |  |  |  | Maturity Date |  |  |  |  | How Payable |  |  |  |  |  |  |  | Balance Due
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
SCHEDULE H |  |  |  |  | REVOLVING AND DEPARTMENT STORE DEBT
Payable to Bankcards |  |  |  |  |  |  | Account Number |  |  |  |  |  |  | Person Liable |  |  |  |  |  |  |  |  |  | How Payable |  |  |  |  |  |  |  | Balance Due
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
Payable to Department Stores |  |  |  |  |  |  | Account Number |  |  |  |  |  |  | Person Liable |  |  |  |  |  |  |  |  |  | How Payable |  |  |  |  |  |  |  | Balance Due
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  | Per |  |  |  |  |  | 0
PRIMARY APPLICANT INFORMATION
Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth
Street Address:
Social Security No. |  |  |  |  | Driver's License No. |  |  |  |  |  | Home Phone |  |  |  |  | Cell Phone |  |  |  |  |  | Business Phone |  |  |  |  | [NAME]
Occupation |  |  |  | Name of Employer |  |  |  |  |  |  |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | No. of Years
Number of dependents? |  |  |  |  |  |  |  |  | Ages? |  |  |  |  |  |  |  |  |  |  | Other Details:
Have you established a trust? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Name of Trust:
Have you made a will? |  |  |  |  |  |  |  |  |  |  |  | Details:
Have any actions or suits been filed against you or are there any unsatisfied judgments or decrees entered against you, or have you been adjudged
bankrupt or made any compromises with creditors?
Have you guaranteed or endorsed the notes of any other person? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Do you have any other contingent liabilities?
CO-APPLICANT INFORMATION
Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth
Street Address:
Social Security No. |  |  |  |  | Driver's License No. |  |  |  |  |  | Home Phone |  |  |  |  | Cell Phone |  |  |  |  |  | Business Phone |  |  |  |  | [NAME]
Occupation |  |  |  | Name of Employer |  |  |  |  |  |  |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | No. of Years
Number of dependents? |  |  |  |  |  |  |  |  | Ages? |  |  |  |  |  |  |  |  |  |  | Other Details:
Have you established a trust? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Names of Trust:
Have you made a will? |  |  |  |  |  |  |  |  |  |  |  | Details:
Have any actions or suits been filed against you or are there any unsatisfied judgments or decrees entered against you, or have you been adjudged
bankrupt or made any compromises with creditors?
Have you guaranteed or endorsed the notes of any other person? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Do you have any other contingent liabilities?
I (we) hereby affirm that the foregoing information contained in this financial statement is presented for the purpose of obtaining credit as of the date indicated and is true, complete and correct.  I understand Lender is relying on this statement of my financial condition in making loan(s) to me.  Lender is authorized to make any investigation of my credit or employment status either directly or through any agency employed by Lender for that purpose.  Lender may disclose to any other interested parties Lender's experience with this account.  I agree to inform the Lender immediately of any matter, which will cause any significant change in my financial condition.  I understand that Lender will retain this financial statement whether or not credit is granted.
Applicant's Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  | Co-Applicant's Signature |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
ADDITIONAL INFORMATION / DETAILS