Sublet Application Form Page 11
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19Purchase Application Part II – Financial Information [cont]
Page 2 of 2
SCHEDULE B
Stocks, Bonds, & Mutual Funds (attach additional pages if necessary) - Total should match Stocks, Bonds, Brokerage Acc. line on previous page.
Amount of Shares
Description
Marketable Value
Non-Marketable Value
SCHEDULE C
Real Estate (attach additional pages if necessary) - Total should match Real Estate line on previous page.
Insur./Maint.
Property Address
Type of Property
Mortgage/Lien Amount
Mortgage Payment
/Taxes/etc
SCHEDULE D
Other Assests (attach additional pages if necessary)
Explanation:
IF YOU ARE A PRINCIPAL OF, OR ARE EMPLOYED BY, A FAMILY BUSINESS, PLEASE COMPLETE THIS SECTION:
Purchaser
Co-Purchaser
Dividend or Partnership Income (current year)
Dividend or Partnership Income (previous year)
Dividend or Partnership Income (2 previous year)
The foregoing application has been carefully prepared, and the undersigned hereby solemnly declare(s) and certify(s) that all information contained herein is complete,
true and correct. The information is submitted as being a true and accurate statement of the financial condition of the undersigned on the
day of
, 20
.
Purchaser
Date
Co-Purchaser (if any)
Date
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