1991-117-RES WHEREAS, funding is available through a special purpose grant to Ark-Tex Council of Governments

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Section 3. SlockS and Bonds: ,II Sf 1111 shlllll il necllssa/)') - Markllt Value Dale No. of Shares Names of Securities Cost Quotalion/ExchanQe Amounl Seclion 4, Real Estate Owned. (List each parcel separately. Use supplemental sheets il neeessa/)'. Each sheet must be idantified as a supplement to this statement and signed), Title is in Dale Original Present Mortgage Amount Stalus 01 Address-Type of property name of Purchased Cosl' Value Balance of Paymenl Mortgage Section 5, Other Personal Property. (Describe, and if any is mortgaged, state name and addrass 01 mortgage holder and amount 01 mortgage, terms 01 payment. and if delinquent. describe delinquency. Seetion 6. Other Assets, Notes & Accounts Receivable (Describe) .' Section 7. Unpaid Taxes, (Describe in detail. as to type, to whom payable, when due, amount, and what, if any, property the tax lian attaches) Section 8. Other Liabilities. (Describe in detai~ Section 9. Life Insurance Held (Give lace amount 01 poficies-name 01 company and beneficiaries) SBA/Lender is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein and to determine mylour creditworthiness. (I) or (We) certify the above and the statements contained in the schedules herein are a true and accurate statement of (my) or (our) financial condition as of Ihe date staled herein. This slatement is given for the purpose of: (Check one 01 the lof/owing) 0 Inducing S,B,A, 10 grant a loan as requested in the application, 10 the individual or firm whose name appears herein. 0 Furnishing a stalement of (my) or (our) financial condition, pursuanlto the terms of the guaranty executed by (me) or (us) at the same time S.B.A. granted a loan to the individual or firm, whose name appears herein. Signature Signature Date SOCIAL SECURITY NO. SOCIAL SECURITY NO. SBA Fo.-m 413 (10-87j .. -