Us Bank Personal Financial Statement Page 2
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3Please contact your banker if you need assistance with completing these schedules. Round all amounts to the nearest $100.
* ANNUAL INCOME
APPLICANT
CO-APPLICANT
PLEASE ANSWER EACH QUESTION (Yes / No)
APP.
CO-APP
Salary
Are you a Co-Maker, Endorser or Guarantor of
any other person’s debt?
Bonuses/Commissions
Dividends/Interest
Are you a defendant in any suit or legal action?
Net Real Estate Income
* Income from alimony, child support, or
Have you ever gone through bankruptcy or had a
maintenance payments need not be entered
judgment against you?
unless you want it considered as a base for
repayment.
Other (List)
Have you made a will?
Total
0
0
SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES AND IRA ACCOUNTS
Name of Bank or Financial Institution
Type of Account
Acct. Balance
Total $
0
SCHEDULE 2 / SECURITIES OWNED
Par Value or
Registered in
Listed or
Current Market
No. of Shares
Description
Name(s) of
Unlisted
Value
Total $
0
SCHEDULE 3 / LIFE INSURANCE
Face Value
Cash Value
Insurance Company
Insured
Beneficiary
of Policy
of Policy
Loans
Total $
0
0
PFS for
CONFIDENTIAL
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