REBNY Financial Statement_BLANK

	A	C	D	F	H	I
1	REBNY Financial Statement
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3	Applicant			Co-Applicant
4	Name:			Name:
5	Address:			Address:
6
7
8	The following is submitted as being a true and accurate statement of the financial condition of the undersigned on:				the 15 day of May, 2023
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10	Assets	Applicant	Co-Applicant	Liabilities	Applicant	Co-Applicant
11	Cash in banks (A)			Notes Payable (E)
12	Money Market Funds			To Banks
13	Contract Deposit			To Relatives
14	Investments: Stocks & Bonds (B)			To Others
15	Investment in Own Business			Installment Accounts Payable
16	Accounts and Notes Receivable			Automobile
17	Real Estate Owned (C)			Other
18	Automobiles			Other Accounts Payable
19	Year & Make:			Real Estate Mortgages (C)
20	Year & Make:			Unpaid Real Estate Taxes
21	Personal Property and Furniture			Unpaid Income Taxes
22	Life Insurance			Chattel Mortgages
23	Cash Surrender Value			Loans on Life Insurance Policies
24	Retirement Funds/ IRA			Outstanding Credit Card Loans
25	401K			Other Debts
26	KEOGH
27	Profit Sharing/Pension Plan
28	Other Assets (D)
29	Total Assets	$0.00	$0.00	Total Liabilities	$0.00	$0.00
30	Combined Assets		$0.00	Combined Liabilities		$0.00
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32	Individual Net Worth	$0.00	$0.00	Combined Net Worth		$0.00
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34	Income Sources - Annual	Applicant	Co-Applicant	Projected Expenses - Monthly	Applicant	Co-Applicant
35	Base Salary			Maintenance
36	Overtime Wages			Apartment Financing
37	Bonus & Commissions			Other Mortgages
38	Dividends and Interest Income			Bank Loans
39	Real Estate Income (Net)			Auto Loans
40	Other Income			Other Expenses
41	Total Income	$0.00	$0.00	Total Expenses	$0.00	$0.00
42	Combined Income		$0.00	Combined Expenses		$0.00
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44	General Banking Information	Applicant	Co-Applicant	Contingent Liabilities
45	Personal Bank Accounts at			As Endorser or Co-maker on Notes
46	Personal Bank Accounts at			Alimony Payments (Annual)
47	Savings & Loans at			Child Support
48	Savings & Loans at			Are you defendant in any legal action?
49	Purpose of Loan			Are there any unsatisfied judgments?
50	Purpose of Loan			Ever taken bankruptcy? Explain
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52	This application has been carefully prepared, and the undersigned hereby solemnly declare(s) and certify(s) that all the information contained herein is true and correct.
53	Applicant:			Co-Applicant: