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r) { <br /> B385 INDIVIDUAL STATEMENT (ier.3/77) 111 oewALa eueLINHINC CO,,NEW ULMi.11141. <br /> For the purpoie,of procuring credit from time to time with the bank. named below, the following is <br /> furnished is- a true and accurate statement of my condition on the date indicated. I agree to notify <br /> said b nk promptly of any Imaterial change in my financial condition. <br /> {e •j �r- <br /> NAMMaE- v ti �'—� ADDRESS_42 do f_ __f w;L�yAt <br /> T dAffM rA, rn A r 're, 3 <br /> BAS BUSINESS OF MA%Blt <br /> FINANCIAL CONDITION ON • 19 <br /> �53 ]s Dollars Cts. LI,tBILIt7ES Dollars <br /> C'ts. <br /> Cash on lieiad and fu-Bank QV Notes Pa able to Banks <br /> Notes Receivable-Secured-Good Notes Pa le to Others d a-arm lain <br /> Notga Re eivable-unae d-Good 19 170' 0 <br /> Accounts P b; - o <br /> Accoun GO <br /> Merchandise Owing to Qx n Co <br /> Farm Products Owing to Relatives <br /> ,L.L:ve--5 oe3c <br /> Chatttl Moxtaqs4bs <br /> Listed Stocks, . <br /> Other Cgrreal Assets ` <br /> (Itemize) O � <br /> Oro <br /> rordl, aUimm ASSETS S' fJ�? 00 rorAL CEWRSxr LIABILITIRS Q <br /> -Other Stggks___qnd o (See Schedule) ldort a e on Homestead <br /> First idoLt e c .' b. Mo <br /> Other Liabilities )) <br /> Life !0 1 6 <br /> i om <br /> Ht+mestead.. .__ ow 060 <br /> Other'Redl E"stdt'e (See Schedule) <br /> Hou ehold Furniture 0 <br /> machinery;' Fikttires &•Equipment ow cell <br /> Automobile dQ Tor," LIdBrLIrr83 <br /> 1 ze <br /> f av �v arJ <br /> TOTAL TOTAL <br /> Specify any of the above assets pled s �.2 Mere Fles fail provision been Fade for Zncome.raxem to date of <br /> + j this Statement? �r r <br /> PROFIT LOSS From To ANNUAL INCOME <br /> Net Sales From p <br /> Less Cost of Goods Sold From <br /> Gross, Profit From Real. Ext-ate Sentals <br /> Leas: Personal"Sa1ar •3 From Investments <br /> hops Other Sources <br /> Expenses S IF <br /> s+ (Spec ty) <br /> NET PROFIT OR LOSS S TOTAL ANNUAL INCOME S <br /> Contingent Liabilities: On Guarantees: On Endorsements: <br /> On Bond o i or 0 <br /> Contingent Liability is cif I <br /> Bank, Accounts: <br /> * You-need not disclose income derived from alimony, child support or separate maintenance unless you wish.us to consider it in eval- <br /> uating your credit-worthiness,but if you do choose to rely on such Inca you must specify its source. <br /> Date Siqned Signature <br />