This
Statement and any applicable supporting schedules may be completed
jointly by both married and unmarried Co-Borrowers if their assets and
liabilities are sufficiently joined so that the Statement can be
meaningfully and fairly presented on a combined basis; otherwise
seperate Statements and Schedules are required. If the Co-Borrower
section was completed about a spouse, this Statement and supporting
schedules must be completed about that spouse also.
Completed
 Jointly
Not
Jointly
|
ASSETSDescription |
Cash
or Market Value |
Cash deposit toward
purchase held by:
|
$ |
| List
checking and saving accounts below |
Name and
address of Bank, S&L, or Credit Union
|
| Acct. no. |
$ |
Name and
address of Bank, S&L, or Credit Union
|
| Acct. no. |
$ |
Name and
address of Bank, S&L, or Credit Union
|
| Acct. no. |
$ |
Name and
address of Bank, S&L, or Credit Union
|
| Acct. no. |
$ |
Stock & Bonds
(Company name/number & description)
|
$ |
Life Insurance net
cash value
Face amount: $ |
$ |
| Subtotal Liquid
Assets |
$ |
| Real estate owned
(enter market value from schedule of real estate owned) |
$ |
| Vested Interest in
retirement fund |
$ |
Net worth of
business(es) owned
(attach financial statement) |
$ |
Automobiles owned
(make and year)
|
$ |
Other Assets
(itemize)
|
$ |
| Total
Assets a. |
$ |
| Liabilities
and Pledged Assets. List the creditor's name, address and
account number for all outstanding debts, including automobile
loans, revolving charge accounts, real estate loans, alimony, child
support, stock pledges, etc. Use continuation sheet, if necessary.
Indicate by (*) those liabilities which will be satisfied upon sale
of real estate owned or upon refinancing of the subject property. |
| LIABILITIES |
Mnthly
Payt. & Mos. Left |
Unpaid
Balance |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Name
and address of Company
Acct. no. |
$
Payt./Mos. |
$ |
Alimony/Child
Support/Seperate Maintenance
Payments Owed to: |
$ |
|
Job
Related Expense (child care, union dues, etc.)
|
$ |
| Total
Monthly Payments |
$ |
| Net
Worth (a minus b) $ |
Total
Liabilities b. |
$ |
|