Complete this form if (1) a sole proprietorship by the proprietor, (2) a partnership by each partner, (3) a corporation by each officer and each stockholder with 20% or more ownership, and/or (4) any other person or entity providing a guaranty on the loan.
(Describe in Section 6)
(Describe in Section 3)
(Describe in Section 4)
(Describe in Section 5)
(Describe in Section 2)
(Total Balance & Monthly Payment)
(Describe in Section 7)
(Describe in Section 8)
**Alimony or child support payments need not be disclosed in “Other Income” UNLESS it is desired to have such payments counted towards total income.**
(Use Separate Sheet if Necessary)
(List each parcel separately. Use supplemental sheets if necessary. Each sheet must be identified as a supplement to this statement and signed.)
Lender is authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein and to determine my/our credit worthiness.
(I) or (We) certify the above and the statements contained in the schedules herein are a true and accurate statement of (my) or (our) financial condition as of the date stated herein. This statement is given for the purpose of (check one of the following):
Inducing LNEDC to grant a loan as requested in the application, to the individual or firm whose name appears herein.
Furnishing a statement of (my) or (our) financial condition, pursuant to the terms of the guaranty executed by (me) or (us) at the same time LNEDC granted a loan to the individual or firm, whose name appears herein.
