USVI Public Records

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Statement of the financial condition of the undersigned as of Cash on Hand/Banks Schedule A Accounts Payable Stocks Bonds Schedule B Notes Payable to Banks Schedule A Accounts & Notes Receivable-Trade Mortgage Payable-Current Schedule D Accounts & Notes Receivable-Other Unpaid Income Taxes Cash Value-Life Insurance Schedule C Accrued Expenses Payable Accrued Income Receivable Notes Payable-Other TOTAL CURRENT ASSETS TOTAL CURRENT LIABILITIES Real Estate Owned Schedule D Mortgage Payable-Long Term Furniture & Fixture-Home & Office Schedule D Automobiles Other Other Assets TOTAL LIABILITIES NET WORTH TOTAL ASSETS TOTAL LIABILITIES & NET WORTH SOURCES OF INCOME PERSONAL INFORMATION Salaries or Commissions Business or Occupation Age Bonus & Dividends Married Not Married Separated Real Estate Income (Rentals) No. of Dependents Other Income* Name of Partner or Officer in any other Venture TOTAL CONTINGENT LIABILITIES GENERAL INFORMATION As Co-Maker, Endorser or Guarantor Are any Assets Pledged? Yes No Legal Claims Have you ever filed for bankruptcy? Yes No Provision for Income Taxes Explain Other Special Debt Bank Names Method of Borrowing Amount Owing Unsecured, Guaranty, Collateral Total as per Statement Name Address *Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered asa basis for repayment of this obligation. ASSETS LIABILITIES Statement Dated Cash Balance SCHEDULE A CASH ON HAND/BANKS Personal Financial Statement Shares & Bonds Name of Security In Name Of Present Market Value In Pledge State to Whom Face Amount Name of Company Beneficiary Type of Cash Value Policy Loans Against Policy Title in Name of Cost Last Appraised Value Mortgage Amount Due Bank Names Date Original Amount Balance Monthly Payments High Credit (Month) (Day) (Year) SCHEDULE B STOCKS AND BONDS For the purpose of procuring and maintaining credit from time to time in any form whatsoever with the above named bank, the undersigned submits the following as being a true and accurate statement of his/her financial condition on the following date, and agrees that if any charge occurs that materially reduces the means or ability of the undersigned to pay all claims or demands against him, the undersigned will immediately and without delay notify the said bank and unless the bank is so notified, it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the undersigned as of the close of business. Signature Signature Signature GIVE NAMES OF BANKS, FINANCE COMPANIES, ETC., WHERE CREDIT HAS BEEN OBTAINED. SCHEDULE C LIFE INSURANCE SCHEDULE D REAL ESTATE OWNED Location, Type of Property and Date Acquired SIGN SIGN SIGN