Financial Statement Form

FINANCIAL STATEMENTS - STANDARD SUBMISSION

1.

Personal and/or corporate financials

2.

First year detailed income and expense pro forma

3.

Three year pro forma operating statement

4.

Pro forma statement of cash flow

5.

Operating statements for past two years for any business presently owned by prospective tenant

6.

Current and previous year's tax returns.

PERSONAL FINANCIAL STATEMENT (Instructions: read and complete this statement) If you are married and not separated and are a resident of California, information about your spouse must be provided and the Consent to Gather Credit information must be signed by your spouse. If you are married and not separated, and unless you indicate otherwise, all income and assets will be presumed to be community property and all debts will be presumed to be liabilities of community property. NAME:

SOCIAL SECURITY #:

MARITAL STATUS:

DEPENDENTS:

‡ Married Date Married:

‡ Unmarried

Number:

‡ Separated

Ages:

TELEPHONE:

(

)

DRIVER’S LICENSE #:

State:

TELEPHONE:

(

)

TELEPHONE:

(

)

#:

ADDRESS: CITY, STATE, ZIP EMPLOYER: ADDRESS: CITY, STATE, ZIP: SPOUSE INFORMATION SECTION NAME: EMPLOYER: ADDRESS: CITY, STATE, ZIP:

FINANCIAL CONDITION AS OF ___________________, 200__

ASSETS

LIABILITIES

CASH ON HAND & IN BANKS (Schedule 1)

NOTES PAYABLE TO BANK

STOCKS AND BONDS - Listed (Schedule 2)

OTHERS (Itemize, Schedule 5)

STOCKS AND BONDS - Unlisted (Schedule 2)

NOTES PAYABLE - REAL ESTATE LOANS (Schedule 3)

REAL ESTATE - Improved (Schedule 3)

SALES CONTRACTS & SEC. AGRMTS (Schedule 5)

REAL ESTATE - Unimproved (Schedule 3)

LOANS ON LIFE INSURANCE POLICES (Schedule 5)

TRUST DEEDS AND MORTGAGES (Schedule 4) TAXES PAYABLE - Current Year's Income Taxes Unpaid LIFE INSURANCE: Cash Surrender Value

TAXES PAYABLE - Prior Year's Income Taxes Unpaid TAXES PAYABLE - Real Estate Taxes Unpaid

ACCOUNTS & NOTES RECEIVABLES: Relatives and Friends (Schedule 5)

OTHER LIABILITIES - Unpaid Interest

Collectable (Schedule 5)

OTHER LIABILITIES - (Itemize, Schedule 4)

Doubtful (Schedule 5)

Auto Loans:

OTHER PERSONAL PROPERTY – Automobile OTHER PERSONAL PROPERTY – Automobile TOTAL LIABILITIES Other (Itemize, Schedule 5)

NET WORTH TOTAL ASSETS

TOTAL

ANNUAL INCOME

ANNUAL EXPENDITURES

SALARY OR WAGES

PROPERTY TAXES AND ASSESSMENTS

DIVIDENDS AND INTEREST

FEDERAL AND STATE INCOME TAXES

RENTALS (Gross)

REAL ESTATE LOAN PAYMENTS

BUSINESS OR PROFESSIONAL INCOME (Net)

PAYMENTS ON OTHER CONTRACTS AND OTHER NOTES

OTHER INCOME DESCRIBE (Spouse/child Support)

INSURANCE PREMIUMS

Child maintenance income need not be listed unless it is to be considered for granting credit

ESTIMATED LIVING EXPENSES OTHER (Alimony, Child Support, Maintenance)

TOTAL INCOME

TOTAL EXPENDITURES

LIFE INSURANCE FACE AMOUNT

BENEFICIARY

COMPANY

If you have details of any contingent liability as endorser or guarantor, or on suits or judgment pending (If necessary, use separate sheet.) __________________________________________________________________________________________________________________________

Do you do business with any other bank? ________ If so, give details _____________________________________________________ Have you ever filed any petition under the Bankruptcy Act?_______________________________________________________________________ Are any of the assets listed on this statement held under a Trust Agreement? † Yes

† No ___________________________

Have your Income Tax Returns ever been questioned by the Internal Revenue Service? _____________ If so, most recent year ________ SCHEDULE 1: CASH ON HAND BANKS

BRANCH

ACCOUNT NO.

BALANCE

SCHEDULE 2: LISTED AND UNLISTED STOCKS AND BONDS OWNED LISTED: NUMBER OF SHARES PER VALUE

DESCRIPTION

JOINT TENANCY TENANTS IN COMMON COMMON PROPERTY

ISSUED IN NAME OF

MARKET VALUE

TOTAL LISTED: UNLISTED:

Are any of the above securities pledged to secure a debt?

SCHEDULE 3: REAL ESTATE OWNED (Designate: I=Improved, U=Unimproved LOCATION OR DESCRIPTION

TITLE IN NAME OF

Joint Tenancy Ten In Common Comm. Property

Cost

PRESENT VALUE

Trust Deeds, Mortgages or other Line Unpaid Bal

Rates

Monthly Payment

Held By

TOTAL

SCHEDULE 4: TRUST DEEDS AND MORTGAGES OWNED Name of Payer

Legal Desc., Street Address & Type of Improvements

Unpaid Bal.

Joint Tenancy Ten. in Common Comm. Property

Term

1st or 2nd Lien

Value of Property

TOTAL

SCHEDULE 5: DETAILS RELATIVE TO OTHER IMPORTANT ASSETS AND LIABILITIES

This statement is furnished in connection with an application for approval of financial status and is to be regarded as continuous until another shall be substituted for it. I hereby certify that I have carefully read the above statement, and it is a complete, true and correct statement to the best of my knowledge and belief. CONSENT TO GATHER CREDIT INFORMATION I authorize the Landlord to make whatever inquiries it considers necessary and appropriate for purposes of reviewing and evaluating this financial statement.

__________________________________________________________ Signature of Applicant Date (g:forms-financial statements landlord)

____________________________________________________ Signature of Spouse Date