Spreadsheet: 17597ea4-db5c-4943-b4d0-d5eb073d45d4
Sheet: Sheet1

Personal Financial Statement | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | as submitted to | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14
DATED:
IMPORTANT: Read these directions before completing this Statement
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.
(PLEASE TYPE OR PRINT)
SECTION 1 - INDIVIDUAL INFORMATION |  |  |  |  |  | [NAME] INFORMATION
 | Name : |  |  |  |  |  |  | Name:
 | Address: |  |  |  |  |  |  | Address:
 | City, State & Zip: |  |  |  |  |  |  | City, State & Zip:
 | Position & Occupation: |  |  |  |  |  |  | Position & Occupation:
 | Business Name: |  |  |  |  |  |  | Business Name:
 | Business Address: |  |  |  |  |  |  | Business Address:
 | City, State & Zip: |  |  |  |  |  |  | City, State & Zip:
 | Length of Employment: |  |  |  |  |  |  | Length of Employment:
 | Res. Phone: |  |  |  |  |  |  | Res. Phone:
 | Bus. Phone: |  |  |  |  |  |  | Bus. Phone:
 | email address: |  |  |  |  |  |  | email address:
SECTION 3 - STATEMENT OF FINANCIAL CONDITION
Assets |  |  |  |  | In Dollars | Liabilities |  |  |  |  |  |  |  | In Dollars
(Do not include asset of doubtful value.) |  |  |  |  | (Omit cents) |  |  |  |  |  |  |  |  | (Omit cents)
Cash on hand  - see Schedule A |  |  |  |  | 0 | Notes payable to Institutions or individuals - see Schedule I |  |  |  |  |  |  |  | 0
U.S. Gov't & Marketable Securities - see Schedule B |  |  |  |  | 0 | Credit Cards
Non-Marketable Securities - see Schedule C |  |  |  |  | 0 | Accounts and Bills due
Real estate owned - see [NAME] |  |  |  |  | 0 | Real estate mortgages payable - see [NAME] |  |  |  |  |  |  |  | 0
Automobiles and other vehicles  - see Schedule E |  |  |  |  | 0 | Unpaid income tax
Accounts, loans and other notes receivable - see Sched. F |  |  |  |  | 0 | Other unpaid taxes and interest
Cash value - life insurance - see [NAME] |  |  |  |  | 0 | Life insurance loans - see [NAME] |  |  |  |  |  |  |  | 0
Book value of business ventures - see Schedule H |  |  |  |  | 0 | Other debts - itemize
Other personal property
Other assets - itemize
 |  |  |  |  |  | TOTAL LIABILITIES |  |  |  |  |  |  |  | 0
 |  |  |  |  |  | NET WORTH |  |  |  |  |  |  |  | 0
TOTAL ASSETS: |  |  |  |  | 0 | TOTAL LIABILITIES AND NET WORTH |  |  |  |  |  |  |  | 0
[NAME] |  |  |  |  |  |  |  | SECTION 5 - CONTINGENT LIABILITIES
For year ended |  |  | Amount |  | Annual Expenditures |  | Amount |  | Contingent Liabilities |  |  |  |  | Amounts
 |  |  |  |  |  |  |  |  |  | Borrower |  | CoBorrower
Salary |  | $ |  | Mortgage/rental payments |  |  |  |  |  | Yes / No |  | Yes / No
Bonuses & Commissions |  |  |  | Utility payments |  |  |  | DO YOU HAVE ANY…
 |  |  |  |  |  |  |  | Contingent liabilities as a
Dividends & interest |  |  |  | Real estate taxes & assessments |  |  |  | co-maker or guarantor? |  | No |  | No
Net real estate income |  |  |  | Taxes: federal, state & local |  |  |  | Involvement in pending
(before debt service) |  |  |  |  |  |  |  | legal actions? |  | No |  | No |  | $
Other income (specify) |  |  |  | Insurance payments |  |  |  | Other special debt or
 |  |  |  |  |  |  |  | circumstance? |  | No |  | No |  | $
 |  |  |  | Other contracts payments |  |  |  | Contested income tax
 |  |  |  | (car payments, charge cards, |  |  |  | liens? |  | No |  | No |  | $
(Alimony, child support or |  |  |  | etc.) |  |  |  | If "yes" to any question, describe your liability.
separate maintenance income |  |  |  |  |  |  |  | Attach extra papers as needed.
need not be revealed if you do |  |  |  | Alimony, child support,
not wish to have it considered |  |  |  | maintenance
as a basis for repaying this
obligation.) |  |  |  | Other expenses
Total Income |  |  | 0 | Total Expenditures |  |  | 0 | Total Contingent Liabilities |  |  |  |  |  | 0
 |  |  |  |  |  | Have you ever been declared bankrupt? |  |  |  | Yes__ |  | No___
Income tax settled through (date) |  |  |  |  |  | If Yes, describe on separate sheet