Spreadsheet: 0f30c80a-5556-4d75-af43-339f8919e16f
Sheet: Sheet1

Unnamed: 0 | CONFIDENTIAL | 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 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Personal Financial Statement | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32
 | SCHEDULE A - CASH, CHECKING, & SAVINGS ACOUNTS, CERTIFICATES OF DEPOSIT, MONEY MARKET FUNDS, ETC. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | To: TOWER BANK & TRUST CO.  FORT WAYNE, IN |  |  | CONFIDENTIAL |  |  |  | Date:
 | Name of Financial Institution |  |  |  | Type of Account |  |  |  |  | Owner |  |  | Joint? |  | Pledged To: |  |  | Balance |  |  |  |  |  |  | IMPORTANT: Read these directions before completing this Statement.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | the credit requested, or if this statement relates to your guaranty of the indebtedness of other person(s), firm(s), or corporation(s), complete only [NAME], and 4
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | repayment of the credit requested, complete all Sections, providing information in Section 2 about the person upon whose alimony, support, or maintenance payments or income or
 | SCHEDULE B - U.S. GOVERNMENTS & MARKETABLE SECURITIES |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | or assets you are relying. Alimony, child support or separate maintenance income need not be revealed if you do not want it considered as a basis for repaying this obligation.
 | Number of Shares | Description |  |  |  | In name of |  |  |  |  | Are these |  |  |  | Market value |  |  | Exchanges Where |  |  |  |  |  |  | If you are applying for joint credit with another person, complete all Sections, providing information in Section 2 about the joint applicant.
 | or face value (bonds) |  |  |  |  |  |  |  |  |  | pledged? |  |  |  |  |  |  | Traded |  |  |  |  |  |  | If this statement relates to your guaranty of the indebtedness of other person(s), firm(s) or corporation(s), complete Sections 1 and 3.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SECTION 1 - INDIVIDUAL INFORMATION (Type or Print) |  |  |  | SECTION 2 - OTHER PARTY INFORMATION (Type or Print)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Name |  |  |  | Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Residence address |  |  |  | Residence address
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Please do not leave any questions unanswered. Use "no" or "none" where necessary. | City, State & Zip |  |  |  | City, State & Zip
 | SCHEDULE C - RETIREMENT ASSETS (401Ks, IRAs) Please Attach Additional Sheet If Necessary |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Position or occupation |  |  |  | Position or occupation
 | Number of shares | Description (Asset Type and Where Held) |  |  |  |  | In name of |  |  |  |  | Are these |  |  |  | Source of |  |  | Value |  |  |  |  |  | Business name |  |  |  | Business name
 |  |  |  |  |  |  |  |  |  |  |  | pledged? |  |  |  | value |  |  |  |  |  |  |  |  | Business address |  |  |  | Business address
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City, State & Zip |  |  |  | City, State & Zip
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]: |  |  |  | [NAME]:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Home Phone: |  |  |  | Home Phone:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SECTION 3 - STATEMENT OF FINANCIAL CONDITION
 | SCHEDULE D - BUSINESS VENTURES & CLOSELY HELD STOCK |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ASSETS |  |  | In Dollars | Joint? | LIABILITIES |  | In Dollars
 | List Name & Address of Any Business In Which You Are A Principal or Partner |  |  | Type of Business |  |  |  | Years in |  | Your |  | Your % |  | Total Assets |  |  | Market |  |  | Method of |  |  |  |  | (Do not include assets of doubtful value) |  |  | (Omit cents) |  |  |  | (Omit cents)
 |  |  |  |  |  |  |  | Business |  | Title |  | Ownership |  |  |  |  | Value |  |  | Valuation |  |  |  |  | Cash on hand and in banks - see [NAME] |  |  | 0 |  | First Mortgage - see [NAME] |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | U.S. Gov't & Marketable Securities - see Schedule B |  |  | 0 |  | Additional Mortgages - see [NAME] |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Retirement Assets - see Schedule C |  |  | 0 |  | Home Equity Loan(s) |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Securites held by broker in margin accounts |  |  |  |  | Automobile Loan(s) |  | 0
 | SCHEDULE E - LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Restricted or control stocks |  |  |  |  | Education Loan(s) |  | 0
 | Name of insurance company |  |  | Owner of policy |  |  |  | Beneficiary |  |  |  |  |  | Face amount |  |  | Policy loans |  |  | Cash surrender |  |  |  |  | Notes & Loans Receivable |  |  |  |  | Credit Card Debt |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | value |  |  |  |  | Business Ventures & Closely-Held Stock |  |  | 0 |  | Other Debts or [NAME]) |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | - see [NAME]
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Personal property
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Cash value-life insurance - see Schedule E |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Real estate owned - see [NAME] |  |  | 0
 | SCHEDULE F - REAL ESTATE OWNED |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other assets (Please Itemize):
 | Address & type of property |  | Title in name of |  |  | % of |  | Year |  | Cost |  |  |  | Market Value |  |  | Monthly |  |  | Mortgage
 |  |  |  |  |  | ownership |  | acquired |  |  |  |  |  |  |  |  | payment |  |  | balance
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL LIABILITIES |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NET WORTH |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL ASSETS |  |  | 0 |  | TOTAL LIABILITIES AND NET WORTH |  | 0
 | SCHEDULE G - BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SOURCES OF INCOME FOR YEAR ENDED: _________________ |  |  | Individual | Joint? | [NAME]
 | Name of lender |  |  |  | Credit in |  |  |  |  |  | Credit |  | Original |  | High credit |  |  | Current |  |  | Monthly |  |  |  | [NAME], bonuses & commissions |  |  |  |  | Do you have a will?    Yes       No        If so, name of executor:
 |  |  |  |  | the name of |  |  |  |  |  | Instrument |  | date |  |  |  |  | balance |  |  | payment |  |  |  | Dividends & Interest
 |  |  |  |  |  |  |  |  |  |  | Home Equity |  |  |  |  |  |  |  |  |  |  |  |  |  | Real estate income |  |  |  |  | Are you a partner or officer in any other venture? If so, describe.
 |  |  |  |  |  |  |  |  |  |  | Auto |  |  |  |  |  |  |  |  |  |  |  |  |  | Other income (Please List)
 |  |  |  |  |  |  |  |  |  |  | Education |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are you obligated to pay alimony, child support or separate maintenance
 |  |  |  |  |  |  |  |  |  |  | Credit Cards |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | payments? If so, describe:
 | (USE ADDITIONAL SCHEDULES IF NECESSARY) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are any assets pledged other than as described on schedules?
 | The information  contained in this  statement is provided for the purpose of  obtaining or maintaining credit with Tower Bank on behalf of the undersigned, |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL  INCOME |  |  | 0
 | or persons, firms or corporations on whose behalf  the undersigned may either severally, or jointly with others, execute a guaranty in your favor.  Each |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | CONTINGENT LIABILITIES |  |  |  |  | Income tax settled through (date)
 | undersigned understands that Tower Bank is relying on the information provided herein (including the designation made as to ownership of property) in |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes         No | Amount | Are you a defendant in any suits or legal actions?
 | deciding to grant or continue credit.  Each undersigned represents and warrants that the information provided is true and complete and that Tower Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Do you have any contingent liabilities? If so, describe: |  |  |  |  | Yes                 No
 | may consider this statement as continuing to be true and correct until a written notice of a change is given to Tower Bank by the undersigned.  Tower |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Have you ever been audited by the IRS?
 | Bank is authorized to make all inquiries it deems necessary to verity the accuracy of the statements made herein, and to determine me/our creditworthiness. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | As endorser, co-maker or guarantor? |  |  |  |  | Yes              No | Date(s)
 | Tower Bank is authorized to answer questions about its credit experience with me/us. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | On leases or contracts? |  |  |  |  | Have (either of) you or any firm in which you were a major owner ever
 | Signature |  |  |  |  |  |  |  | Signature (Other party) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | As a defendant to legal action? |  |  |  |  | declared bankruptcy or settled any debts for less than the amounts
 | S.S.N. |  |  | D.O.B. |  |  |  |  | S.S.N. |  |  |  |  |  |  |  | D.O.B. |  |  |  |  |  |  |  | Any contested income tax liens? |  |  |  |  | owed? If so, please describe on a separate sheet.
 | Date Signed |  |  |  |  |  |  |  | Date Signed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other special debt or circumstances? If so, describe: |  |  |  |  | Yes                No