Core Express Personal Financial Statement

Select a choice
ASSETS
LIABILITIES

SOURCE OF INCOME

Source of Income: Alimony, child support or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation. Do not include income of co-applicant unless joint applicant or such income is to be considered as a basis of repayment.

I/We authorize and instruct any person or credit reporting agency to complete and furnish Bank any information that such person or agencies may have to obtain in response to such credit inquiries and agree such information along with this application, shall remain your property whether or not credit is extended.

The undersigned hereby certify that both sides hereof and the information inserted therein has been carefully read and is true, correct and complete. I/We agree to notify the bank of any significant changes in my/our financial condition.

TWO SIGNATURES REQUIRED FOR Joint Statement

PERSONAL INFORMATION
Partner or officer in any other venture?
Do you have a will?
Are you a defendant in any legal suits or actions? (include in Schedule H)
Bankruptcy?

SCHEDULES

Please complete the below only if you do not have an accountant prepared Personal Financial Statement.

SCHEDULE A - Deposit Accounts
SCHEDULE B - Government Securities
SCHEDULE C - Unlisted Securities
SCHEDULE D - Life Insurance
SCHEDULE E - Real Estate Owned
SCHEDULE F - Deferred Compensation & Retirement Plans (401K, IRA, Keough, Annuities)
SCHEDULE G - Notes & Accounts Payable
SCHEDULE G - Notes & Accounts Payable