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<br />~ OMB AppIaval No, 3245-0188 <br /> PERSONAl FINANCIAL STATEMENT Exp. Date: 1~1-89 <br />. . <br />,.,~~~",,,, Aaol 19_ <br />Complete this lorm il 1) a sole proprietorslllp by the PftlPrietor; 2) a partnership by each partner; 3) a corporation by each oIIIcar and <br />each stockholder with 20% or more ownerslllp; 4) any oIher parson or entity providing a gU!lfanty on !he loan. <br />Name Residence Phone <br />Residence Address <br />CIlv. State &Zio <br />Business Name 01 Applicanl/Borrower <br />ASSETS UABILITIES <br /> (Om" Cants) (Om" Cants) <br />Cash on hand & in Banks. . .. . .. .. .. . .. . . ..$ Accounts Payable........................$ <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 />Lne Insurance--Cash Installment Account (Other) <br />Surrender Value Only. . . . . . . . . . . .. . . . . .. Mo. Payments S <br />Stocks and Bonds Loans on L~e Insurance.................. <br />(Describe in Section 3) .................. Mortgages on Real Estate................. <br />Real Estate (Describe In Section 4)................._ <br />(Describe In Section 4) .. . . . . . .. .. . .. .. . . Unpaid Taxes <br />Automobile-Present Value. . . . . . . . . . . . . . . . . (Describe in Section 7).................. <br />Other Personal Proparty . . . . . . .. . . .. . .. . .. . Other Liabilities <br />(Describe In Section 5) (Describe in Section 8).. . .. . . . . .. .. .. . .. <br />Other Assets......................... .... <br />(Describe in Section 6) .................. Total Liabilities........................... <br /> Net Worth............................... <br />Total. . .. . . . . .. . .. .. . . . . . .. .. . ..$ Total. . . . .. .. . . .. . .. . . . .. . .. .. .. .$ <br />Section 1. Source 01 Income Contingent Liabilities <br />Salary ............................ $ Aa Endorser or Co-Maker .. ...... ...... .......... .....$ <br />Net Investment Income. . . . . . . . . . . . . legal Claims & Judgments. : .. .. .. .. .. .. .. .. .. . .. .. ... <br />Real Estate Income.. . , . . . . . . . . . .. . Provision lor Fed Income Tax. . . . . . . . . . . . . . . . . . . . .. .. .. <br />Other Income (Describe)' . . . . . . . . . . . Other Special Debt............. ..... ............. .... <br />Description olllems listed in Section I <br />"(Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted <br />toward total income.) <br />~tion2. Notes Payable to Banks and Uthers <br />Name & Address 01 Original Currant Payment Terms How Secured or <br />Noteholder Balance Balance Amount (Monthly..tc.) Endorsed-- Type 01 Collateral <br />SBA Form 413 (10-87) Use 1 ().86 edition until exhausted ReIer to SOP 50 10 <br /> (Response Is required to obtain a benefit) <br /> <br /><4 <br />