Spreadsheet: 5d725688-eac4-44ee-a948-df8700280d8c
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Financial Condition as of: | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11
www.wnbonline.com |  |  |  |  | Please Complete Fully
The following assets, liabilities, income and expenses on this financial statement represent a (an) (check one of the following):
 | Individual financial statement |  |  | List all your income, expenses, assets and liabilities if this is an individual financial statement.
 | Individual and Community |  |  | List all your individual and community property income, expenses, assets and liabilities.  Exclude all separate property assets and income of your spouse if this is an individual and community property financial statement.  Separate property assets are assets owned or claimed by your spouse before marriage, or acquired by your spouse during marriage by gift or inheritances, or recovered from personal injuries sustained by your spouse during marriage or acquired from the proceeds of liquidation of any of the preceding.
 | Property financial statement
 | Joint financial statement |  |  | List all income, expenses, assets and liabilities of you and your spouse if this is a joint financial statement.
Personal Information
[NAME] |  |  |  |  |  |  | Co-Applicant Name
Employer |  |  |  |  |  |  | Employer
Business Phone No. |  |  |  |  |  |  | Business Phone No.
Home Phone No. |  |  |  |  |  |  | Home Phone No.
Home Address |  |  |  |  |  |  | Home Address
Social Security No. |  |  |  |  |  |  | Social Security No.
State Drivers License No. |  |  |  |  |  |  | State Drivers License No.
Date of Birth |  |  |  |  |  |  | Date of Birth
E-Mail Address |  |  |  |  |  |  | E-Mail Address
Name of Accountant |  |  |  |  |  |  | Name of Accountant
 | Yes | No | Please answer the following questions as appropriate.  Explain in "Additional Comments" below responses to any "Yes" answer.
1. |  |  | Are any of the assets listed on this financial statement located outside the United States of America?
2. |  |  | Are any of the assets listed on page 2 held in trust, in an estate or in any other name or capacity?
3. |  |  | Do any of your assets secure debts which have not been reported on this financial statement?
4. |  |  | Have you ever filed for personal bankruptcy, had any property you owned foreclosed, or made a settlement or an assignment for the benefit of a creditor?
5. |  |  | Has any corporation or partnership in which you are (were) an owner or a general partner ever filed for bankruptcy, had property foreclosed, or made a settlement or assignment for the benefit of a creditor?
6. |  |  | Are you, or any corporation or partnership in which you are an owner or partner, a party to a law suit or legal action?
7. |  |  | Do you have any unsatisfied legal judgments against you?
8. |  |  | Are any income tax returns, whether personal or that of any corporation or partnership in which you are an owner or general partner, currently being audited or contested?
9. |  |  | Are any personal, corporate or partnership income tax returns or payments delinquent?
Additional Comments
I (We), the undersigned, hereby submit this personal financial statement and supporting schedules to Western National Bank for the purpose of inducing the Bank to extend or maintain credit whether as direct obligor(s) or indirectly as guarantor(s) or other indirect obligor(s) of credit extended to others.  I (We) hereby certify that this statement presents a true, complete, and correct statement of financial condition as of the date shown and does not omit any pertinent information.  I (We) understand that misrepresenting information on this statement, or its supporting schedules, is a criminal offense under federal law.  I (We) further agree to promptly notify Western National Bank, in writing, of any negative material change in my (our) financial condition.  And, I (We) hereby authorize Western National Bank to contact credit reporting agencies and other sources for the purposes of determining creditworthiness, verifying information stated herein, and to answer any questions about my credit standing with Western National Bank .
Applicant's Signature |  |  |  | Date |  |  | Co-Applicant's Signature |  |  |  | Date
If you intend to apply for joint credit, please initial here
 |  |  |  |  |  |  | Applicant |  |  |  | Co-Applicant