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PERSONAL FINANCIAL STATEMENT
CONFIDENTIAL
                       
PERSONAL INFORMATION
  Please Print or Type           If joint statement, complete the following:      
  Name (Applicant)           Name ( Co-Applicant)        
                       
  Date of Birth     Social Security Number   Date of Birth     Social Security Number
                       
  Street Address           Street Address        
                       
  City, State, Zip Code           City, State, Zip Code        
                       
  Home Phone Number     Business Phone Number   Home Phone Number     Business Phone Number
                       
  Present Employer           Present Employer        
                       
  Street Address           Street Address        
                       
  City, State, Zip Code           City, State, Zip Code        
                       
  Position         No. of Years   Position         No. of Years
                       
                       
FAMILY INFORMATION
  No. of Children/Dependents   Ages       Do you have a will?   If yes, date of will   Name of Personal Representative
                       
  Do you have a trust?   If yes, date of trust   Name of Trustee/Successor Trustee        
                       
                       
Cash Income and Expenditures Statement For the Year Ending:            
                       
ANNUAL INCOME AMOUNT ($) ANNUAL EXPENDITURES AMOUNT ($)
  Salary (Applicant)        $     Property Taxes/Assessments      $  
  Salary (Co-Applicant)           Income, State, and Other Taxes      
  Bonuses & Commissions           Rental Payments        
  Dividend Income           Mortgage Payments (Principal & Interest)      
  Interest Income           Other Loan Payments        
  Rental Income           Contract Payments (Car, Charge Card, Etc.)    
  Partnership/Sub-S Withdrawals (E, F)         Partnership/Sub-S Contributions (E, F)      
  Capital Gains           Insurance Payments        
  Other Investment Income           Alimony, Child Support Maintenance      
  Other Income (List)*           Education Expenses        
              Other Living Expenses        
              Other Expense        
    TOTAL INCOME        $ 0.00     TOTAL  EXPENDITURES        $ 0.00
                       
* The undersigned need not disclose income from alimony, child support or separate maintenance payments if such income is not to be considered as a source for repayment of the financial accommodations.
                       
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Personal_Financial_Statement2.xls




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