REBNY Financial Statement
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ABCDEFGHI
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REBNY Financial Statement
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ApplicantCo-Applicant
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Name:Name:
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Address:Address:
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The following is submitted as being a true and accurate statement of the financial condition of the undersigned on:the 16 day of May, 2018
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AssetsApplicantCo-ApplicantLiabilitiesApplicantCo-Applicant
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Cash in banks (A)Notes Payable (E)
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Money Market Funds To Banks
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Contract Deposit To Relatives
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Investments: Stocks & Bonds (B) To Others
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Investment in Own BusinessInstallment Accounts Payable
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Accounts and Notes Receivable Automobile
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Real Estate Owned (C) Other
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AutomobilesOther Accounts Payable
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Year & Make:Real Estate Mortgages (C)
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Year & Make:Unpaid Real Estate Taxes
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Personal Property and Furniture
Unpaid Income Taxes
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Life InsuranceChattel Mortgages
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Cash Surrender ValueLoans on Life Insurance Policies
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Retirement Funds/ IRAOutstanding Credit Card Loans
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401KOther Debts
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KEOGH
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Profit Sharing/Pension Plan
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Other Assets (D)
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Total Assets$0.00$0.00Total Liabilities$0.00$0.00
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Combined Assets$0.00Combined Liabilities$0.00
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Individual Net Worth$0.00$0.00Combined Net Worth$0.00
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Income Sources - AnnualApplicantCo-ApplicantProjected Expenses - MonthlyApplicantCo-Applicant
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Base SalaryMaintenance
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Overtime WagesApartment Financing
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Bonus & CommissionsOther Mortgages
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Dividends and Interest INcomeBank Loans
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Real Estate Income (Net)Auto Loans
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Other IncomeOther Expenses
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Total Income$0.00$0.00Total Expenses$0.00$0.00
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Combined Income$0.00Combined Expenses$0.00
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General Banking InformationApplicantCo-ApplicantContingent Liabilities
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Personal Bank Accounts atAs Endorser or Co-maker on Notes
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Alimony Payments (Annual)
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Savings & Loans atChild Support
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Are you defendant in any legal action?
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Purpose of LoanAre there any unsatisfied judgments?
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Ever taken bankruptcy? Explain
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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.
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Applicant:Co-Applicant:
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