Personal Financial Statement - Financial Security Bank Page 2
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4CO-APPLICANT
Full Name___________________________________________________________________
Street Address_________________________________________________________________
City, State, Zip_________________________________________________________________
County__________________ Driver’s License #_________________ Expiration____________
Own
Rent
Since_________________
Email___________________________________
Social Security #________________________ Date of Birth______________________
Phone #_____________________ Work #________________ Cell #______________________
Employer______________________________________________________________________
Address_______________________________________________________________________
Position/Title_______________________________ Since_______________________________
Marital Status: Unmarried
Married
Separated
Please complete schedules 1 thru 6 on the following pages before the section below.
ASSETS (round to nearest $100)
LIABILITIES (round to nearest $100)
(Refer to schedules 1 thru 5 on following page for detail)
(Refer to schedules 4 thru 6)
Cash, Savings, CDs, Money Mkt.
Notes payable --banks
(schedule 1)
(schedule 6)
Marketable Securities/Stocks/Bonds
Notes payable --others
(schedule 2)
(schedule 6)
Retirement, IRA, profit share, Keogh
Installment loans/contracts
(schedule 3)
(schedule 6)
Cash value life ins. (whole life only)
Loans against life insurance
(schedule 4)
(schedule 4)
Homestead
Personal mortgage (homestead)
(schedule 5)
(schedule 5)
Other personally held real estate
Other personal mortgages
(schedule 5)
(schedule 5)
Com'l Real Estate owned
Com'l mortgage debt
(schedule 5)
(schedule 5)
Value of my companies excluding Real Estate
Taxes due
Total credit card debt
(schedule 6)
Other loans
(schedule 6)
Deferred income/receivables (describe)
Autos, Other Personal Property (describe)
0
Total Liabilities:
$
0
Total Assets:
$
Net Worth
:
$
0
(total assets less total liabilities)
(Use attachments if more space is needed)
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