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{"sheet":"Statement","index":0,"n_rows":63,"n_cols":15,"rows_kept":63,"cut":false,"hidden":false,"merged":[[8,9,8,14],[12,9,12,14],[13,9,13,14],[14,9,14,14],[9,9,9,14],[10,9,10,14],[11,9,11,14],[9,2,9,5],[10,2,10,5],[11,2,11,5],[12,2,12,5],[16,9,16,14],[17,9,17,14],[15,9,15,14],[3,0,4,14],[1,1,1,2],[7,2,7,5],[8,2,8,5],[7,9,7,14],[17,2,17,5],[13,2,13,5],[14,2,14,5],[15,2,15,5],[16,2,16,5]],"flags":["formulas_cached_only"]}
["Personal Financial Statement",{"$nulls":7},"           as submitted to "]
["DATED: "]
["IMPORTANT: Read these directions before completing this Statement"]
["You are applying for individual credit in your own name and are relying on your own income, or assets and not the income or assets of another person as the basis for repayment of the credit requested."]
[]
["(PLEASE TYPE OR PRINT)"]
["SECTION 1 - INDIVIDUAL INFORMATION ",{"$nulls":5},"SECTION 2 - OTHER PARTY INFORMATION"]
[null,"Name :  ",{"$nulls":6},"Name:  "]
[null,"Address:  ",{"$nulls":6},"Address:  "]
[null,"City, State & Zip:  ",{"$nulls":6},"City, State & Zip:  "]
[null,"Position & Occupation:  ",{"$nulls":6},"Position & Occupation:  "]
[null,"Business Name:  ",{"$nulls":6},"Business Name:  "]
[null,"Business Address:  ",{"$nulls":6},"Business Address:  "]
[null,"City, State & Zip:  ",{"$nulls":6},"City, State & Zip:  "]
[null,"Length of Employment:  ",{"$nulls":6},"Length of Employment:  "]
[null,"Res. Phone:  ",{"$nulls":6},"Res. Phone:  "]
[null,"Bus. Phone:  ",{"$nulls":6},"Bus. Phone:  "]
[null,"email address:  ",{"$nulls":6},"email address:  "]
[]
["SECTION 3 - STATEMENT OF FINANCIAL CONDITION"]
["Assets",{"$nulls":4},"In Dollars","Liabilities",{"$nulls":7},"In Dollars"]
["(Do not include asset of doubtful value.)",{"$nulls":4},"(Omit cents)",{"$nulls":8},"(Omit cents)"]
["Cash on hand  - see Schedule A",{"$nulls":4},0,"Notes payable to Institutions or individuals - see Schedule I",{"$nulls":7},0]
["U.S. Gov't & Marketable Securities - see Schedule B",{"$nulls":4},0,"Credit Cards"]
["Non-Marketable Securities - see Schedule C",{"$nulls":4},0,"Accounts and Bills due"]
["Real estate owned - see Schedule D",{"$nulls":4},0,"Real estate mortgages payable - see Schedule D",{"$nulls":7},0]
["Automobiles and other vehicles  - see Schedule E",{"$nulls":4},0,"Unpaid income tax"]
["Accounts, loans and other notes receivable - see Sched. F",{"$nulls":4},0,"Other unpaid taxes and interest"]
["Cash value - life insurance - see Schedule G",{"$nulls":4},0,"Life insurance loans - see Schedule G",{"$nulls":7},0]
["Book value of business ventures - see Schedule H",{"$nulls":4},0,"Other debts - itemize"]
["Other personal property"]
["Other assets - itemize"]
[]
[]
[]
[]
[{"$nulls":6},"TOTAL LIABILITIES",{"$nulls":7},0]
[{"$nulls":6},"NET WORTH",{"$nulls":7},0]
["TOTAL ASSETS:",{"$nulls":4},0,"TOTAL LIABILITIES AND NET WORTH",{"$nulls":7},0]
[]
["SECTION 4 - ANNUAL INCOME & EXPENSES",{"$nulls":7},"SECTION 5 - CONTINGENT LIABILITIES"]
["For year ended  ",null,null,"Amount",null,"Annual Expenditures",null,"Amount",null,"Contingent Liabilities",{"$nulls":4},"Amounts"]
[{"$nulls":10},"Borrower",null,"CoBorrower"]
["Salary",null,"$",null,"Mortgage/rental payments",{"$nulls":5},"Yes / No",null,"Yes / No"]
["Bonuses & Commissions",null,null,null,"Utility payments",null,null,null,"DO YOU HAVE ANY…"]
[{"$nulls":8},"Contingent liabilities as a"]
["Dividends & interest",null,null,null,"Real estate taxes & assessments",null,null,null,"co-maker or guarantor?",null,"No",null,"No"]
["Net real estate income",null,null,null,"Taxes: federal, state & local",null,null,null,"Involvement in pending"]
["  (before debt service)",{"$nulls":7},"legal actions?",null,"No",null,"No",null,"$"]
["Other income (specify)",null,null,null,"Insurance payments",null,null,null,"Other special debt or"]
[{"$nulls":8},"circumstance?",null,"No",null,"No",null,"$"]
[{"$nulls":4},"Other contracts payments",null,null,null,"Contested income tax "]
[{"$nulls":4},"  (car payments, charge cards,",null,null,null,"liens?",null,"No",null,"No",null,"$"]
["(Alimony, child support or",null,null,null,"  etc.)",null,null,null,"If \"yes\" to any question, describe your liability."]
["separate maintenance income",{"$nulls":7},"Attach extra papers as needed."]
["need not be revealed if you do ",null,null,null,"Alimony, child support, "]
["not wish to have it considered",null,null,null,"maintenance"]
["as a basis for repaying this "]
["obligation.)",null,null,null,"Other expenses"]
[]
["Total Income",null,null,0,"Total Expenditures",null,null,0,"Total Contingent Liabilities",{"$nulls":5},0]
[{"$nulls":6},"Have you ever been declared bankrupt?",null,null,null,"Yes__",null,"No___"]
["Income tax settled through (date) ",{"$nulls":5},"If Yes, describe on separate sheet"]

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["SCHEDULE A - BANKS, SAVINGS & LOANS, CREDIT UNIONS (ETC.) WHERE FUNDS ARE ON DEPOSIT"]
[]
[{"$nulls":5},"Type of ",{"$nulls":4},"Amount on"]
[null,"Name of Institution",null,"Location",null,"Deposit",null,"Name(s) of Owner(s)",null,null,"Deposit"]
[]
[]
[]
[]
["SCHEDULE B - U.S. GOVERNMENT & MARKETABLE SECURITIES"]
["      Number of Shares",{"$nulls":7},"Market","Loans against Securities"]
["      or Face Value (Bonds)",null,null,"Description",null,null,"In Name Of",null,"Value","Original","Current"]
[]
[]
[]
["SCHEDULE C - NON-MARKETABLE SECURITIES"]
["Number ",null,null,"Location and Nature",null,null,null,"%","Market","Source of","Loans against"]
["of Shares","      Name of Corporation",null,"of Business",null,"In Name Of",null,"Ownership","Value","Value","Securities"]
[]
[]
[]
["SCHEDULE D - REAL ESTATE (WHOLLY OR PARTIALLY OWNED)"]
[{"$nulls":4},"% of","Date",null,"Market","Annual","Mortgage","Mortgage"]
["Address & Type of Property",null,"      Title in Name of",null,"Ownership","Acquired","Cost","Value","Payment","Balance","Maturity"]
[]
[]
[]
[]
[]
[]
["ADDITIONAL REAL ESTATE TOTALS PER SCHEDULE D1     ",{"$nulls":5},0,0,0,0]
["SCHEDULE E - AUTOMOBILES",{"$nulls":4},"SCHEDULE F - ACCOUNTS, LOANS, NOTES RECEIVABLE"]
[{"$nulls":7},"Original ",null,null,"Current"]
["Year, Make, Model of Vehicle",null,"Mileage","Value",null,"Type of Account",null,"Amount","Name of Borrower",null,"Value"]
[]
[]
[]
["SCHEDULE G - LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE"]
[{"$nulls":8},"Policy Loans",null,"Surrender"]
[null,"Name of Insurance Company",null,"      Owner of Policy",null,"           Beneficiary",null,"Face Amount","Original Amt","Balance","Value (Cash)"]
[]
[]
[]
["SCHEDULE H - BUSINESS VENTURES"]
["List Name of Business Ventures",null,null,"Business Net Worth",null,"Your % of","    Your Position/Title",null,"Total Assets","Line of","Years in"]
["in Which You Are a Principal or Partner",{"$nulls":4},"Ownership","       In the Business",null,"of Business","Business","Business"]
[]
[]
[]
["SCHEDULE I - NOTES PAYABLE"]
[{"$nulls":5},"Original","Date of","Maturity ","If Secured","Current","Payment"]
["Name of Creditor",null,null,"Purpose","Rate","Loan Amount","Loan","Date","list collateral","Balance","Schedule"]
[]
[]
[]
[]
[]
[]
["The information contained in this statement is provided for the purpose of obtaining or maintaining credit with Alliance Bank on behalf of the undersigned, or persons, firms, or corporations in whose behalf the undersigned may either seperately, or jointly with others, execute a guaranty in favor of Alliance Bank.  Each undersigned understands that Alliance Bank is relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that Alliance Bank may consider this statement as continuing to be true and correct until a written notice of a change is given to Alliance Bank by the undersigned. As long as a loan or commitment to lend is outstanding, the undersigned agree to update this financial statement for Alliance Bank annually.  Alliance Bank is authorized to make all inquiries it deems necessary to verify the accuracy of the statements made herein, and to determine my/our credit worthiness. Alliance Bank is authorized to answer questions about its credit experience with me/us.  "]
[]
[]
[]
[]
[]
[]
["  "]
["Signature ","  ",{"$nulls":4},"Signature"]
["Date Signed ",null,"Date of Birth",null,null,null,"Date Signed",null,"Date of Birth"]
["S.S. No.",{"$nulls":5},"S.S. No."]
[]
[]
[]
[]
["SCHEDULE D1 - ADDITIONAL REAL ESTATE (WHOLLY OR PARTIALLY OWNED)"]
[{"$nulls":4},"% of","Date",null,"Market","ANNUAL","Mortgage","Mortgage"]
["Address & Type of Property",null,"      Title in Name of",null,"Ownership","Acquired","Cost","Value","Payment","Balance","Maturity"]
{"$rows_empty":7}
["TOTAL OF SCHEDULE D1",{"$nulls":5},0,0,0,0]