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

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Section 3. Stocks and Bond. '!!..!en..rate sheet if necessary) Market Value Date No. of Shares Names of Securities Cost Quotation/Exchange Amount Section 4, Real Estate Owned. (Ust each parcel separately. Use supplemental sheets if necessary. Each sheet must be identified as a supplement 10 this statement and signed). Trtle is in Date Original Present Mortgage Amount Status of Address-Type ot property name ot Purchased Cost Value Balance of Payment Mortgage Section 5. Other Personal Property. (Describe. and if any is mortgaged. state name and address of mortgage holder and amount of mortgage, terms of payment, and if delinquent, describe delinquency, Section 6. Other Assets. Notes & Accounts Receivable (Describe) :section 7. Unpaid Taxes. (Describe in detail, as 10 type, to whom payable. when due, amount, and what. if any, property the tax lien attaches) Section 8. Other Liabilities, (Describe in detail) Section 9. Lite Insurance Held (Give face amount of policies name of company and beneficiaries) ISBA/Lender is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein and to determine my/our 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 the date stated herein. This statement is given for the purpose of: (Check one of the fo/lowing) 0 Inducing S,B,A. to grant a loan as requested in the application, to the individual or firm whose name appears herein. 0 Furnishing a statement of (my) or (our) financial condition, pursuant to 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 :Sl)\;IAL :s!::cUHII Y No. SOCIAL SECURITY NO. SBA Form 413 (10-87) 35 (It IlAnpn.1J1M,.''''.....q.Il,,&~