Spreadsheet: 223c56db-5538-4d80-96c6-29ea9cc0bc80
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Personal Financial Statement prepared for Bank of Lancaster (Confidential) | Unnamed: 11 | Unnamed: 12 | Unnamed: 13
 |  |  |  |  |  |  |  |  |  | Please Supply All Applicable Information. Use Additional Pages if [NAME].
 |  |  |  |  |  |  |  | Soc Sec #
Name |  |  |  |  |  |  |  | Birth date
 |  |  |  |  |  |  |  | Home Phone
Address: |  |  |  |  |  |  |  | Work Phone
 |  |  |  |  |  |  |  | Cell Phone
 |  |  |  |  |  |  |  | [NAME]
[NAME] (If spousal) |  |  |  |  |  |  |  | Soc Sec #
 |  |  |  |  |  |  |  | Birth date
Address: |  |  |  |  |  |  |  | Home Phone
 |  |  |  |  |  |  |  | Work Phone
 |  |  |  |  |  |  |  | Cell Phone
 |  |  |  |  |  |  |  | [NAME]
Personal Financial Statement as of: |  |  |  |  |  |  |  |  | (Month, Day, Year)
[NAME] filed through (date): |  |  |  |  |  | Are any returns being audited or contested (Y/N)?
Assets |  |  |  |  |  | Liabilities
Cash on Hand in Bank of Lancaster |  |  |  |  |  | Notes payable to Bank(s)-Secured (other than real
 |  |  |  |  |  | estate)- complete [NAME]
Cash on Hand in Other Banks |  |  |  |  |  | Notes payable to Bank(s)-Unsecured- complete
 |  |  |  |  |  | Schedule A
Listed Securities- complete Schedule E |  |  |  |  |  | Notes payable to relatives- complete [NAME]
Unlisted Securities- complete Schedule E |  |  |  |  |  | Notes payable to others- complete [NAME]
Retirement Accounts/IRAs |  |  |  |  |  | Accounts payable (including credit cards)-
 |  |  |  |  |  | complete [NAME]
Cash Value Life Insurance- complete |  |  |  |  |  | Loans secured by assigned Life Insurance
Schedule C |  |  |  |  |  | complete [NAME]
Accounts and Notes Receivable |  |  |  |  |  | Accrued taxes and interest
Due from relatives and friends
Accounts and Notes Receivable |  |  |  |  |  | Other unpaid taxes
Due from others - good
Accounts and Notes Receivable |  |  |  |  |  | Mortgages payable on Real Estate- complete
Due from others - doubtful |  |  |  |  |  | Schedule F
Real Estate owned- complete [NAME] |  |  |  |  |  | Other debts - itemize
Machinery and [NAME] complete
Schedule G
Personal Property- complete [NAME]
Automobiles:
Year & Make
Year & Make |  |  |  |  |  | Total Liabilities |  |  |  | 0
Year & Make
Other Assets- complete [NAME] |  |  |  |  |  | Net Worth |  |  |  | 0
Total Assets |  |  | 0 |  |  | Total Liabilities And Net Worth |  |  |  | 0
Do any of the assets belong in whole or part to any other person? |  |  |  |  |  | If yes, please explain:
Contingent Liabilities |  |  |  |  |  | Name & Address of Employer
As endorser, co-maker |  |  | Provision for Federal
or guarantor |  |  | Income Taxes
On leases |  |  | Alimony or other
or contracts |  |  | similar obligations |  |  | Position |  |  |  |  | No. of
Legal claims |  |  | Other special debt |  |  |  |  |  |  |  | Dependents
 |  |  |  |  |  | Partner or officer in
Income from alimony, child support or separate maintenance payments |  |  |  |  |  | any other venture
need not be revealed if you do not wish to have it considered as a |  |  |  |  |  | Have you executed a will (Y/N)?
basis for repaying credit to be extended by Lender. |  |  |  |  |  | Name of Executor:
Yearly Sources of Income |  |  |  |  |  | General Information
Salary |  |  | Real Estate |  |  | Are any assets pledged other than |  |  | Are you a defendant in any suits or legal
 |  |  | Income |  |  | indicated above? |  |  | actions?
Bonus and |  |  | Other |  |  | Personal bank
Commissions |  |  | Income |  |  | accounts carried at
Dividends |  |  | TOTAL | 0 |  | Have you ever taken bankruptcy? |  |  |  | Yes |  | No
and Interest |  |  |  |  |  | If yes, when?
Note Payable Detail- Schedule A
 |  |  |  |  |  |  |  |  |  | "X" those that apply
Name of Bank/Other Creditor |  |  | Balance on Deposit |  | Amount of Indebtedness |  |  | Monthly Payment |  | Credit Line | Secured | Unsecured
Accounts Payable/Credit Card Detail- Schedule B
Name of Bank or Company |  |  |  |  | Credit Limit |  |  | Amount Outstanding |  |  | Monthly Payment
Life Insurance Detail- Schedule C
Name of Company |  |  | Owner(s) |  |  | Face Amount |  | Cash Value | Loans | Beneficiary
Disability Insurance Detail- Schedule D
Name of Company |  |  | Name Insured |  |  | Monthly Distribution |  | Number of Years Covered
Stocks and Bonds Detail- Schedule E
 |  |  |  |  |  |  | No of Shares or |  |  |  | Pledged/Restricted
Name of Corporation and Description of Stocks or Bonds |  |  |  | Owner(s) |  |  | Face Value of Bonds |  | Market Value |  | Yes | No
Real Estate Detail- Schedule F
 |  |  | Original | Year of |  |  | Estimated | Mortgage | Monthly | Monthly
Address and Type of Property |  |  | Cost | Purchase | Owner(s) |  | Value | Or [NAME] | Payment | Income | Lender
Other Assets (Including Investments in other Businesses, Equipment and other Personal Property) Detail- Schedule G
No of Unit | Description |  |  |  |  |  |  |  | Unit Value |  | Total Value
The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue to grant or to accept a guarantee thereof. Each of the undersigned represents, warrants and certifies that the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify you as required above, or if any of the information herein should prove to be inaccurate or incomplete in any material respect, you may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable. You are authorized to make all inquires you deem necessary to verify the accuracy of the information contained herein and to determine the credit-worthiness of the undersigned. The undersigned authorize any person or consumer reporting agency to give you any information it may have on the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. As long as any obligation or guarantee of the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or other information that the undersigned gives you shall be your property.
(Signature) |  |  |  |  |  |  |  |  | (Date Signed)
(Signature) |  |  |  |  |  |  |  |  | (Date Signed)