A. Cash in Banks & Notes Due to Banks (List all Real Estate Loans in Schedule E)
See Attached Itemization
B. Life Insurance (List only those Policies that you own)
C. Securities Owned (Including U.S. Gov't Bonds and all other Stocks & Bonds)
D. Notes & Accounts Receivable (Money Payable or Owed to You Individually-Indicate % of your Ownership)
E. Real Estate Owned (Indicate % of your Ownership Interest)
F. Mortgages and Contracts Owned (Indicate % of your Ownership Interest)
G. Personal Property (Indicate % of your Ownership Interest)
H. Notes, Accounts, Bills & Contract Payable
This information and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representation made in this Statement will be relied on by Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the undersigned. Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any question about Creditor's credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of influencing the actions of Creditor can be a violation of federal law 18 U.S.C. sec. 1014 and may result in a fine or imprisonment or both.
In addition, each individual signing below authorizes the Creditor to check their individual credit account, employment history, and have a credit reporting agency prepare a credit report on them.
The undersigned declares that he/she has read and understands the statement above.
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