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<br /> OMS ~rov. No. 324S-0188 <br /> PEASONAL. FINANCIAL. STATEMENT E.q). Oat.: 10-31-87 <br /> AI of 19- <br /> <br /> Complete this form if 1) a sole proprietorship by the proprietor; 2) . pannersnip by each penner; 3) a corporation by each officer and <br /> each stockholder with' 0 'It or more ownership; 4) any other person or entity providing a guaranty on the loan. <br /> Name Not Applicable Residence Phone <br /> Residence Address <br /> CItY. State, & liD <br /> Business Name of Applicant/Borrower <br /> ASSETS LIABIUTIES <br /> (Omit Cents) (Omit Cents) <br /> Cash on hand & in Banks.. .. . . .. ..........$ AccountsPayable........................$ <br /> Savings Accounts......................... Notes Payable (to Bk & Others <br /> IRA.......,.............................. (Describe in Section 2).. .. . .. .. .. .. . .. .. <br /> Accounts & Notes Receivable Installment AcCount (Auto) <br /> (Describe in Section 6) .................. Mo. Payments $ <br /> Life Insurance-Cash Installment Account (Other) <br /> Surrender Value Only. .. . . . . . . . . .. . .. .. . Mo. Payments $ <br /> Stocks and Bonds Loans on Ute Insurance. .. .. .. . .. .. .. .. . . <br /> (Describe in Section 3) """"""""" Mortgages on Real Estate. . . . . . . . . . . . . . . . . <br /> Real Estate (Describe in Section4).................. <br /> (Describe in Section 4) .................. Unpaid Tax.. <br /> Automobile-Present Value. . . . . . . . . . . . . . .. (Describe in Section 7)....... ........... <br /> Other Personal Property................... Other Uabilitles <br /> (Describe in Section 5) (Describe in Section 8).................. <br /> Other Assets ....................'......... <br /> (Describe in Section 6) .................. TotaJUaÞilitIes........................... <br /> NetWOtth ............................... <br /> Total...........................$ Total. . . . . . . . . . . . . . . . . . . . . . . . . . . .$ <br /> Section 1. Source of Income Contingent Uabilities <br /> Salary ..... .. . .. . .. . . .. .. .. .. .. ... $ MEndorserorCo-MaKer .............................$ <br /> Net Investment Income. . . . . . . . . . . .. L.egaJ Claims & Judgments. ............ ............... <br /> Real Estate Income. . .. .. .. .. . . . ... ProvIsion tor Fed Income Tax.......................... <br /> Other Income (Describe). . . . . . . . . . .. Other Special Debt ................................... <br /> Description of Items Listed in Section I <br /> <br /> '(Alimony or child suppon payments need not be disctosed in "omer Income" unless it is desired to have such payments counted <br /> toward total income.) <br /> Section 2. Notes Payable to Banks and omers <br /> Name & Address of OriglnaJ Current Payment Tenns How Secured or <br /> Noteholder Balance Balance Amount (Monthly-etc.) Endorsed- T~ of Collateral <br /> <br /> <br /> <br /> <br /> i <br /> (Response is required to obtain a benefit) <br /> 47 <br />