Bbva Compass Financial Statement (Page 3 of 3) in pdf

ALL QUESTIONS BELOW MUST BE ANSWERED

I understand that the following questions are addressed to me and I have answered them as appropriate.

Yes

1. Are any of the Assets held in trust, in an estate or in any other name or capacity?

Yes

2. Were any of the Assets (1) owned or claimed by your spouse before marriage; or (ii) acquired by your spouse during marriage by

gift or inheritances; or (iii) recovered for personal injuries sustained by your spouse during marriage; or (iv) acquired from the

proceeds of liquidation of any of the preceding?

Yes

3. Are any of your real estate properties used by you in your business?

Yes

4. Do any of your Assets secure any debts which have not been reported in the preceding schedules?

Yes

5. Are you a party to any suit or are there any unsatisfied judgments against you?

Yes

6. Have you been through bankruptcy or made an assignment for benefit of creditors?

I have explained fully under “Additional Remarks” on this page any “Yes” answers to the foregoing questions.

Yes

7. I have a will; the executor is

Yes

8. Do you reside in Florida?

Yes

9. If you answered Yes to 8, are any of the Assets jointly owned by you and your spouse?

Yes

10. If you answered Yes to 8 and 9, do you and your spouse intend for the jointly owned assets to be held as tenants by the entirety?

If you answered Yes to 8 and 9, but No to 10, then your spouse must confirm the same to us in writing.

The above financial and supporting schedules, which are submitted to you for the purpose of obtaining credit from you, present a true, complete and correct

statement of my financial condition as of the date shown. I understand that misrepresenting information on this statement is a criminal offense under federal law

punishable by a fine and/or imprisonment. I will notify you in writing of any material unfavorable change in my financial condition. In the absence of such notice,

you may consider this a continuing statement and substantially correct. If I apply for further credit, this statement shall have the same force and effect as if

delivered as an original statement of my financial condition at the time I request such further credit. You are authorized to contact any appropriate third parties

for the purpose of verifying any stated information herein or at any time furnished by me to you, and obtaining credit information at any time from any of my

creditors and or credit reporting agencies. This financial statement and any other information furnished to you shall be your property. You are authorized to

answer questions about your credit experience with me. It is understood that the information provided herein may be shared with any subsidiary or affiliate.

SIGNATURE

DATE

SIGNATURE

DATE

(SPOUSE- If Applicable)

SIGNATURE

DATE

(WITNESS)

REMARKS: LIST OTHER PERSONAL ASSETS/LIABILITES, ATTACH ANY OTHER PERTINENT INFORMATION, OR LEAVE COMMENTS

Revised 11/19/2013

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