Spreadsheet: 01dd0036-f81f-4f20-a21d-b85016aa0025
Sheet: Sheet1

FINANCIAL STATEMENT FOR CORPORATION | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20
Include ONLY items relating to activity of the Corporation
From:
Office Address |  |  |  |  |  |  |  |  |  |  | Branch Office
Type of Business |  |  |  |  |  |  |  |  |  |  | Location of Plant
To
For the purpose of obtaining loans and discounting paper with you, and otherwise procuring credit from time to time, we furnish the following, which is and is shown by our books to be a true and accurate statement of our financial condition.
We agree to and will notify you immediately in writing of any materially unfavorable change in our financial condition, and in the absence of such notice, or of a new and full written statement, this may be considered as a continuing statement and substantially correct; and it is hereby expressly agreed that upon application for further credit, this statement shall have the same force and effect as if delivered as an original statement of our financial condition at the time such further credit is requested.
FINANCIAL STATEMENT OF CONDITION
AS OF
NOTE: COMPLETE PAGES 2 & 3 BEFORE COMPLETING THE REMINDER OF THIS PAGE
ASSETS |  |  |  |  |  |  |  |  |  |  | LIABILITIES
CASH, SAVINGS, AND OTHER DEPOSITS IN THIS BANK |  |  |  |  |  |  |  | 0 |  |  | NOTES PAYABLE                                                         Trade |  |  |  |  |  |  |  | 0
CASH IN OTHER FINANCIAL INSTITUTIONS |  |  |  |  |  |  |  | 0 |  |  | NOTES PAYABLE                                                          Banks |  |  |  |  |  |  |  | 0
NOTES RECEIVABLE                                                                          from customers (current) |  |  |  |  |  |  |  | 0 |  |  | NOTES PAYABLE                                                 Other |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | other
ACCOUNTS RECEIVABLE                                          from customers (current) |  |  |  |  |  |  |  | 0 |  |  | ACCOUNTS PAYABLE                                          Current |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | Current
INVENTORY: Schedule A |  |  |  |  |  |  |  | 0 |  |  | ACCOUNTS PAYABLE                                          Past Due |  |  |  |  |  |  |  | 0
Now Valued |  |  | 0 |  |  |  |  |  |  |  | Past Due
TOTAL CURRENT ASSETS |  |  |  |  |  |  |  | 0 |  |  | DEPOSITS OF MONEY |  |  |  |  |  |  |  | 0
INVESTMENTS: Schedule B                                             Bonds and Stocks |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | BONDED DEBT
MACHINERY AND EQUIPMENT                                    Schedule C |  |  |  |  |  |  |  | 0 |  |  | MORTGAGE DEBT: Schedule D
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
FURNITURE AND FIXTURES |  |  |  |  |  |  |  |  |  |  | ACCRUED PAYROLL
 |  |  |  |  |  |  |  |  |  |  | include payroll taxes, etc.
REAL ESTATE: Schedule D |  |  |  |  |  |  |  | 0 |  |  | REAL ESTATE TAXES DUE AND PAYABLE
NOTES RECEIVABLE, from customers doubtful |  |  |  |  |  |  |  |  |  |  | INCOME TAXES |  |  | Federal
(estimated face value |  |  |  |  |  |  | ) |  |  |  |  | State |  |  |  |  |  |  | 0
BILLS AND ACCOUNTS RECEIVABLE: Schedule E |  |  |  |  |  |  |  |  |  |  | OTHER TAXES OWNING
due from officers, stockholders or employees |  |  |  |  |  |  |  | 0
DUE FROM CONTROLLED OR SUBSIDIARY CONCERNS |  |  |  |  |  |  |  |  |  |  | RESERVES: Schedule G
[NAME] |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  | 0
OTHER ASSETS
Itemize |  |  |  |  |  |  |  |  |  |  | TOTAL ASSETS |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  | CAPITAL STOCK
 |  |  |  |  |  |  |  |  |  |  |  | Preferred outstanding
 |  |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  |  |  |  | SURPLUS
 |  |  |  |  |  |  |  |  |  |  | including Undivided Profits |  |  |  |  |  |  |  | 0
Total Assets |  |  |  |  |  |  |  |  |  |  | TOTAL LIABILITIES & NET WORTH |  |  |  |  |  |  |  | 0
INCORPORATED under the laws of what state? |  |  |  |  |  |  |  |  |  |  |  |  | Date:
I, the undersigned officer of this corporation, acquainted with its affairs and duly authorized to contract liabilities, hereby certify and declare that the foregoing statement and representations, and the schedules and representations on the reverse side hereof, constitutes a true and accurate account of the conditions of this corporation as of the date first above written.
In witness whereof, I have hereunto affixed the corporate name and seal as the act and deed of said corporation.
 |  |  |  |  |  |  |  | NAME OF CORPORATION:
 | (Corporate Seal)
 |  |  |  |  |  |  |  | By:
 |  |  |  |  |  |  |  | Date Signed:
OFFICERS |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  | President
 |  |  |  |  |  |  |  | Vice-President
 |  |  |  |  |  |  |  | Treasurer
 |  |  |  |  |  |  |  | Secretary
Statements submitted to Federal Reserve Bank must either be signed originals or certified copies.  If copies are furnished certificate must be officially signed by the member bank.
We hereby certify that the foregoing is a true and correct copy of a signed financial statement of the above mentioned corporation now on file in this bank, and that , to the best of our knowledge and belief, this statement reflects the true condition of the borrower.
NAME OF MEMBER BANK:
OFFICIAL SIGNATURE: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Title:
Statements certified by public accountants may, at the discretion of the Management Committee of the Federal Reserve Bank , be accepted
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