Personal Financial Statement - US Bank
PFS for CONFIDENTIAL Page 3 of 3
SCHEDULE 4 / RECEIVABLES DUE TO ME ON MORTGAGES AND CONTRACTS I OWN
Name of Debtor Description of Property
First Lien or
Second Lien
Date of
Maturity Repayment Terms Balance Due
per
per
per
Total $ 0
SCHEDULE 5 / REAL ESTATE OWNED
Property Description Name of Creditor
Year
Acquired
Purchase
Price
Mortgage
Balance
Date of
Maturity Repayment Terms
Current Market
Value
per
per
per
per
per
per
Insurance Co.: Agent:
Total $ 0
SCHEDULE 6 / PROFIT SHARING AND PENSION
Name of Institution Type of Account
Account
Balance
Amount Totally
Vested Loans
Total $000
SCHEDULE 7 / INSTALLMENTS, CREDIT LINES AND NOTES
Name of Creditor Collateral
Date of
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
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