Us Bank Personal Financial Statement Page 3
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3SCHEDULE 4 / RECEIVABLES DUE TO ME ON MORTGAGES AND CONTRACTS I OWN
First Lien or
Date of
Name of Debtor
Description of Property
Second Lien
Maturity
Repayment Terms
Balance Due
per
per
per
Total $
0
SCHEDULE 5 / REAL ESTATE OWNED
Year
Purchase
Mortgage
Date of
Current Market
Property Description
Name of Creditor
Acquired
Price
Balance
Maturity
Repayment Terms
Value
per
per
per
per
per
per
Insurance Co.:
Agent:
Total $
0
SCHEDULE 6 / PROFIT SHARING AND PENSION
Account
Amount Totally
Name of Institution
Type of Account
Balance
Vested
Loans
Total $
0
0
0
SCHEDULE 7 / INSTALLMENTS, CREDIT LINES AND NOTES
Date of
Name of Creditor
Collateral
Maturity
Repayment Terms
Balance Due
per
per
per
per
Total $
0
SCHEDULE 8 / CREDIT ACCOUNTS, BILLS DUE, ALIMONY/CHILD SUPPORT, DAYCARE, ETC.
Name of Company
Repayment Terms
Balance Due
per
per
per
per
per
Total $
0
You certify that the information provided in this statement is true and correct. So long as you owe any sums to the bank, you agree to give the bank
prompt written notice of any material change in your financial condition and, upon request, you agree to provide the bank with an updated personal
financial statement. The bank is authorized to retain this personal financial statement whether or not credit is approved and is further authorized to verify
your credit and employment history or any other information in this statement. This application does not obligate the bank to make any loan even if you
meet the normal standards the bank considers in determining whether to approve or deny the application.
Applicant’s Signature
Date
Co-Applicant’s Signature
Date
PFS for
CONFIDENTIAL
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