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["Please do not leave any questions unanswered.  Use \"no\" or \"none\" where necessary.",null,null,null,null,null,null,null,null,null,null,null,"Personal Financial Statement",null,null,null,null,null,null,null,null,null,null,null,false,false,true,true]
[null,"(Confidential)",null,null,null,null,null,null,null,null,null,null,null,null,null,"Page 1 of 2"]
[null,null,null,null,"IMPORTANT: Read these directions and check appropriate selection before completing this Statement"]
[]
[null,null,null,"I am applying for individual credit or to act as individual guarantor for the indebtedness of another party and am relying on my own income or assets and not the income or assets of another party as the basis for repayment of the credit requested. Complete only sections 1 and 3 and all applicable schedules. "]
[]
[]
[null,null,null,"We are applying for joint credit or to act as joint guarantors or co-borrowers for the indebtedness of another party. Complete sections 1, 2 and 3, and all applicable schedules, providing information in Section 2 about the joint applicant or joint guarantor or co-borrowers."]
[]
[null,null,null,"I am applying for individual credit and will be relying on income from alimony, child support, or separate maintenance or on the income or assets of another individual as the basis for repayment of the credit requested.  Complete all sections and applicable schedules, providing information in Section 2 about the individual upon whose alimony, support, or maintenance payments, income or assets you are relying."]
[]
[]
[]
[null,"We intend to apply for joint credit or to act as joint guarantors for the indebtedness of another party: "]
[]
[null,null,null,null,null,"Individual (Section 1)",null,null,null,null,null,"Other Party (Section 2)"]
[]
[null,null,"SECTION 1 - INDIVIDUAL INFORMATION (Type or Print)",null,null,null,null,null,null,null,"SECTION 2 - OTHER PARTY INFORMATION (Type or Print)"]
[null,null,"Name",null,null,null,null,null,null,null,"Name"]
[null,null,"Residence address",null,null,null,null,null,null,null,"Residence address"]
[null,null,"City, State & Zip",null,null,null,null,null,null,null,"City, State & Zip"]
[null,null,"Position or occupation",null,null,null,null,null,null,null,"Position or occupation"]
[null,null,"Business name",null,null,null,null,null,null,null,"Business name"]
[null,null,"Business address",null,null,null,null,null,null,null,"Business address"]
[null,null,"City, State & Zip",null,null,null,null,null,null,null,"City, State & Zip"]
[null,null,"Res. Phone*",null,"(        )","Bus. Phone*","(        )",null,null,null,"Res. Phone*","(        )","Bus. Phone*","(        )"]
[]
[null,null,null,null,null,null,null,null,"SECTION 3 - STATEMENT OF FINANCIAL CONDITION AS OF: ","                                                                                                       ,                            "]
[null,"ASSETS",null,null,null,null,null,"In Dollars",null,"LIABILITIES",null,null,null,null,"In Dollars"]
[null,"(Do not include assets of doubtful value)",null,null,null,null,null,"(Omit Cents)",null,null,null,null,null,null,"(Omit Cents)"]
[null,null,"Cash on hand and in banks",null,null,null,null,0,null,null,"Notes payable to banks - secured - see Schedule F",null,null,null,{"$f":"SUM(Schedules!C94:C97)","v":0}]
[null,null,"U.S. Gov't & Marketable Securities - see Schedule A",null,null,null,null,{"$f":"SUM(Schedules!R6:S9)","v":0},null,null,"Notes payable to banks - unsecured - see Schedule F",null,null,null,{"$f":"SUM(Schedules!B94:B97)+SUM(Schedules!D94:D97)","v":0}]
[null,null,"Non-Marketable Securities - see Schedule B",null,null,null,null,{"$f":"SUM(Schedules!R14:S17)","v":0},null,null,"Due to brokers",null,null,null,0]
[null,null,"Securities held by broker in margin accounts",null,null,null,null,0,null,null,"Amounts payable to others - secured",null,null,null,0]
[null,null,"Restricted or control stocks",null,null,null,null,0,null,null,"Amounts payable to others - unsecured",null,null,null,0]
[null,null,"Partial interest in real estate - see Schedule C (Market Value x % Ownership) ",null,null,null,null,{"$f":"SUM(Schedules!M22:O25)","v":0},null,null,"Accounts and bills due",null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,"Unpaid income tax",null,null,null,0]
[null,null,"Real estate owned - see Schedule D",null,null,null,null,{"$f":"SUM(Schedules!M30:O33)","v":0},null,null,"Other unpaid taxes and interest",null,null,null,0]
[null,null,"Loans Receivable",null,null,null,null,0,null,null,"Real estate mortgages payable - see Schedules C (Mortgage Bal x % Ownership) and D (Mortgage Bal)",null,null,null,{"$f":"SUM(Schedules!R22:S25)+SUM(Schedules!R30:S33)","v":0}]
[null,null,"Automobiles and other personal property",null,null,null,null,0]
[null,null,"Cash value-life insurance - see Schedule E",null,null,null,null,{"$f":"SUM(Schedules!R38:S41)","v":0},null,null,"Other debts - itemize",null,null,null,0]
[null,null,"Other assets - itemize",null,null,null,null,0,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,0,null,null,"TOTAL LIABILITIES",null,null,null,{"$f":"SUM(O31:P43)","v":0}]
[null,null,null,null,null,null,null,0,null,null,"NET WORTH",null,null,null,{"$f":"H46-O44","v":0}]
[null,null,"TOTAL ASSETS",null,null,null,null,{"$f":"SUM(H31:I45)","v":0},null,null,"TOTAL LIABILITIES AND NET WORTH",null,null,null,{"$f":"O44+O45","v":0}]
[null,null,"SOURCES OF INCOME FOR YEAR ENDED:                                               ",null,null,null,null,null,null,"PERSONAL INFORMATION"]
[null,null,"Salary, bonuses & commissions",null,null,null,null,0,null,"Personal bank accounts carried at:"]
[null,null,"Dividends",null,null,null,null,0]
[null,null,"Real estate income",null,null,null,null,0,null,"Do you have a will?"]
[null,null,"Other income (Alimony, child support, or separate maintenance",null,null,null,null,0,null,"  If Yes, name of executor:"]
[null,null,"    income need not be revealed if you do not wish to have it",null,null,null,null,0,null,"Are you a partner or officer in any other venture?"]
[null,null,"    considered as a basis for repaying this obligation)",null,null,null,null,0,null,"  If Yes, describe:"]
[null,null,null,null,null,null,null,0,null,"Are you obligated to pay alimony, child support, or"]
[null,null,null,null,null,null,null,0,null,"separate maintenance payments?"]
[null,null,"TOTAL",null,null,null,null,{"$f":"SUM(H48:I55)","v":0},null,"   If Yes, describe:"]
[null,"CONTINGENT AND OTHER LIABILITIES",null,null,null,null,null,null,null,"Are any assets pledged other than as described on the"]
[null,"Do you have any contingent liabilities…",null,null,null,null,null,null,null,"schedules?"]
[null,null,null,"as an endorser, co-maker or guarantor?",null,null,null,null,null,"   If Yes, describe:"]
[null,null,null,"on leases or contracts?",null,null,null,null,null,"Are any assets held in a Trust?"]
[null,null,null,"on other special debt?",null,null,null,null,null,"   If Yes, please identify:"]
[null,"If Yes to any contingent liabilities, describe:",null,null,null,null,null,null,null,"Check the \"Yes\" box if you have ever been convicted of a felony."]
[null,"Are there any judgments, legal claims, or lawsuits pending?",null,null,null,null,null,null,null,"   If Yes, please explain:"]
[null,"If Yes, describe:",null,null,null,null,null,null,null,"If needed, use the space below to provide additional information for any questions answered \"Yes\":"]
[null,"Are any State or Federal taxes (Income, Withholding, Sales or Property) "]
[null,"delinquent or disputed?"]
[null,"If Yes, describe:"]
[null,"Have there been any bankruptcies or judgments?"]
[null,"If Yes, describe:"]
[null,"Revised 5/16",null,null,null,"(Complete schedules and sign on Page 2)"]
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["Pick List"]
[]
["Yes"]
["No"]

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["CONFIDENTIAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Page 2 of 2"]
[]
["SCHEDULE A - U.S. GOVERNMENT & MARKETABLE SECURITIES"]
["Number of shares or face value (bonds)","Description",null,null,null,null,null,null,"In name of",null,null,null,null,null,"Are these \npledged?",null,null,"Market value"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
["SCHEDULE B - NON-MARKETABLE SECURITIES"]
["Number of shares","Description",null,null,null,null,"In name of",null,null,null,"Are these pledged?",null,null,null,"Source of \nvalue",null,null,"Value"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
["SCHEDULE C - PARTIAL INTERESTS IN REAL ESTATE "]
["Address & type of property",null,"Title in name of",null,null,"% of ownership",null,"Date\nacquired",null,"Cost",null,null,"Market value",null,null,"Monthly \npayment",null,"Mortgage \nbalance"]
[]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[]
["SCHEDULE D - REAL ESTATE OWNED"]
["Address & type of property",null,"Home-\nstead? (Yes/No)","Title in name of",null,null,null,"Date\nacquired",null,"Cost",null,null,"Market value",null,null,"Monthly \npayment",null,"Mortgage \nbalance"]
[]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,0,null,null,0,null,null,0,null,0]
[]
["SCHEDULE E - LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE"]
["Name of insurance company",null,null,"Owner of policy",null,null,null,"Beneficiary",null,null,null,null,"Face amount",null,null,"Policy loans",null,"Cash surrender \nvalue"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[]
["SCHEDULE F - DEBT WITH OTHER BANKS OR FINANCIAL INSTITUTIONS"]
["Name of lender",null,null,null,"Credit in \nthe name of",null,null,null,null,"Secured or unsecured?",null,"Original \ndate",null,"High credit",null,null,"Current \nbalance",null,"Monthly payment"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,null,0,null,0]
[]
["(USE ADDITIONAL SCHEDULES IF NECESSARY)"]
[]
["Signature (Individual)                                                                                                                                                                              ",null,null,null,null,null,null,null,null,"Signature (Other party)                                                                                                                                                                              "]
[]
["S.S. No.                                                                                                       ",null,null,"Date of Birth                                                          ",null,null,null,null,null,"S.S. No.                                                                                                       ",null,null,null,null,null,"Date of Birth                                                                                    "]
[]
["Date Signed                                                                                                                                                                                             ",null,null,null,null,null,null,null,null,"Date Signed                                                                                                                                                                                             "]
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["SCHEDULE F CALCULATION AREA"]
[null,"Blank","Secured","Unsecured"]
[null,{"$f":"IF(J46=\"\",Q46,0)","v":0},{"$f":"IF(J46=\"secured\",Q46,0)","v":0},{"$f":"IF(J46=\"Unsecured\",Q46,0)","v":0},"Yes"]
["Secured",{"$f":"IF(J47=\"\",Q47,0)","v":0},{"$f":"IF(J47=\"secured\",Q47,0)","v":0},{"$f":"IF(J47=\"Unsecured\",Q47,0)","v":0},"No"]
["Unsecured",{"$f":"IF(J48=\"\",Q48,0)","v":0},{"$f":"IF(J48=\"secured\",Q48,0)","v":0},{"$f":"IF(J48=\"Unsecured\",Q48,0)","v":0}]
[null,{"$f":"IF(J49=\"\",Q49,0)","v":0},{"$f":"IF(J49=\"secured\",Q49,0)","v":0},{"$f":"IF(J49=\"Unsecured\",Q49,0)","v":0}]
[null,{"$f":"SUM(B94:B97)","v":0},{"$f":"SUM(C94:C97)","v":0},{"$f":"SUM(D94:D97)","v":0}]