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["Personal Financial Statement"]
[]
["First National Bank of Cokato"]
["365 Broadway Ave S, PO Box 490"]
["Cokato, MN 55321"]
["Telephone (320) 286-2191"]
["Fax  (320) 286-2194"]
[]
["CONTACT YOUR REPRESENTATIVE AT THE BANK IF YOU HAVE ANY"]
["QUESTIONS REGARDING THE COMPLETION OF THIS FORM"]
[]
["YOU MAY APPLY FOR A CREDIT EXTENSION OR FINANCIAL ACCOMMODATION INDIVIDUALLY OR JOINTLY WITH A CO-APPLICANT."]
["THIS STATEMENT AND ANY APPLICABLE SUPPORTING SCHEDULES MAY BE COMPLETED JOINTLY BY BOTH MARRIED AND UNMARRIED"]
["CO-APPLICANTS IF THEIR ASSETS AND LIABILITIES ARE SUFFICIENTLY JOINED SO THAT THE STATEMENT CAN BE MEANINGFULLY AND"]
["AND FAIRLY PRESENTED ON A COMBINED BASIS; OTHERWISE SEPARATE STATEMENTS AND SCHEDULES ARE REQUIRED."]
[]
[]
["DATE:  "]
[]
[]
["APPLICANT"]
[]
[]
["NAME: ",null,"SSN:"]
[]
["ADDRESS: ",null,"DATE OF BIRTH:"]
[]
[null,null,"PHONE NO.:"]
[]
["PRESENT EMPLOYER:",null,"POSITION:"]
[]
[]
["ADDRESS:"]
[]
[]
[]
[]
["CO-APPLICANT"]
[]
[]
["NAME:",null,"SSN:"]
[]
["ADDRESS:",null,"DATE OF BIRTH:"]
[]
[null,null,"PHONE NO.:"]
[]
["PRESENT EMPLOYER:",null,"POSITION:"]
[]
[]
["ADDRESS:"]
[]
[]
[]
[]
["ASSETS","AMOUNT","LIABILITIES","AMOUNT"]
["Cash - Personal",null,"Notes Payable Banks (Sch #5)",0]
["Cash - Other",null,"Due Dept Stores, Credit Cards & others"]
["Account Receivables",null,"Income Taxes Payable"]
["Due from Friends, Relatives and others",null,"Other Taxes Payable"]
["Securities Owned (Sch #1)",0]
["Cash Surrender Value of Life Insur. (Sch #2)",0,"Loan on Life Insurance (Sch #2)"]
["Retirement & Pension Funds"]
["401K Plan"]
[]
[]
[]
["Total Current Assets",0,"Total Current Liabilites",0]
[]
["Homestead",null,"Mortgage on Homestead"]
["Other Real Estate Owned (Sch #3)",0,"Mortgage or Liens on Other RE (Sch #4)",0]
["Automobiles",null,"Other Liabilities (Detail)"]
["Machinery"]
["Personal Property"]
["Other Assets "]
[]
[]
[]
[null,null,"Total Liabilities",0]
[null,null,"Net Worth (Total Assets Less Total Liab.)",0]
["Total",0,"Total  ",0]
[]
[]
["ANNUAL INCOME","Applicant","ANNUAL INCOME","Co-Applicant"]
["Salaries",null,"Salaries"]
["Commissions",null,"Commissions"]
["Interest",null,"Interest"]
["Rentals",null,"Rentals"]
["Alimony, Child Support",null,"Alimony, Child Support"]
["Maintenance(you need not show this unless",null,"Maintenance(you need not show this unless"]
["you wish us to consider it)",null,"you wish us to consider it)"]
["Other",null,"Other"]
[]
["Total Income",0,"Total Income",0]
[]
[]
["CONTINGENT LIABILITIES"]
["As Endorser"]
["As Guarantor"]
["Lawsuits"]
["For Taxes"]
["Other (Detail)"]
[]
[]
["Check here if none "]
[]
["Total Contingent Liabilities",0]
[]
[]
[]
["Schedule 1 Securities Owned Due From Others"]
["Desription","Cost","In Whose Name(s)","Present Value"]
[]
[]
[]
[null,null,"Total",0]
["Schedule 2 Life Insurance & Retirement"]
["Company","Face Value","Insured & Beneficiary","Cash Value"]
[]
[]
[]
[null,null,"Total",0]
[]
["Schedule 3 - Other Real Estate - Asset"]
["Address and Type","Title Under","Yr. Acquired & cost","Market Value"]
[]
[]
[]
[null,null,"Total",0]
[]
["Schedule 4 Other Real Estate - Liability"]
["To Whom Payable","how Payable","Int. Date & Maturity Date","Loan Balance"]
[]
[]
[]
[]
[null,null,"Total",0]
[]
["Schedule 5 Notes Payable Banks & Others"]
["To Whom Payable","How Payable","Collateral","Loan Balance"]
[]
[]
[]
[]
[null,null,"Total",0]
[]
[null,"Applicant",null,"Co-Applicant"]
["Have you ever gone through bankrupcy            YES",null,"YES"]
["or had a judgement against you?                  NO",null,"NO"]
[]
["Are any assets pledged or debts secured        YES",null,"YES"]
["except as shown?                                       NO",null,"NO"]
[]
["Have you made a will?                                 YES",null,"YES"]
["NO",null,"NO"]
[]
["Number of Dependants         (If none, write none)"]
[]
["(Answer the following only if this Financial Statement is provided in connection with a request for secured credit of applicant is seeking"]
["a joint account with spouse.)"]
[]
["MARITAL STATUS                                 Married",null,"Married"]
["                                                        Separated",null,"Separated"]
[" (includes Single, Divorced, Widowed)          Unmarried",null,"Unmarried"]
[]
[]
["The foregoing, statement submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the"]
["time indicated.  I/We will give you prompt written notice of any substantial change in such financial condition occurring before discharge of my/our "]
["obligations to you. I/We understand that you will retain this personal financial statement whether or not you approve the credit in connection with which"]
["it is submitted. You are authorized to check my/out credit and employment history or any other information contained herein."]
[]
["THE UNDERSIGNED CERTIFY THAT THE INFORMATION ON THIS FORM "]
["HAS BEEN CAREFULLY REVIEWED AND THAT IT IS TRUE AND CORRECT IN ALL RESPECTS"]
[]
[]
[]
["Applicant",null,"Date"]
[]
[]
["Co-Applicant",null,"Date"]