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: ‡ Married ‡ Unmarried ‡ Separated

Date Married: TELEPHONE: ( )

DEPENDENTS: Number: Ages: DRIVER’S LICENSE #: State: #:

ADDRESS:

CITY, STATE, ZIP

EMPLOYER: TELEPHONE: ( )

ADDRESS:

CITY, STATE, ZIP:

SPOUSE INFORMATION SECTION

NAME:

EMPLOYER: TELEPHONE: ( )

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 ESTIMATED LIVING EXPENSES
considered for granting credit
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: DESCRIPTION ISSUED IN NAME OF JOINT TENANCY MARKET VALUE
NUMBER OF SHARES PER VALUE TENANTS IN COMMON
COMMON PROPERTY

TOTAL LISTED:

UNLISTED:

Are any of the above securities pledged to

secure a debt?

SCHEDULE 3: REAL ESTATE OWNED (Designate: I=Improved, U=Unimproved Trust Deeds, Mortgages or other Line
LOCATION OR DESCRIPTION TITLE IN NAME OF Joint Tenancy Cost PRESENT Unpaid Bal Rates Monthly Held By
Ten In Common VALUE Payment
Comm. Property

TOTAL

SCHEDULE 4: TRUST DEEDS AND MORTGAGES OWNED

Name of Payer Legal Desc., Street Address & Unpaid Bal. Joint Tenancy Term 1st or 2nd Value of Property
Type of Improvements Ten. in Common Lien
Comm. 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 Signature of Spouse Date
(g:forms-financial statements landlord)