SECTION 1: INDIVIDUAL INFORMATION (TYPE OR PRINT)
SECTION 2: OTHER PARTY INFORMATION (TYPE OR PRINT)
$ Personal Financial
Name: Address: City: State: Zip: Phone: Length at Present Address: Social Security #: Date of Birth: Business Name: Position or Occupation: Business Address: City: State: Zip: Business Phone: Length of Employment:
Name: Address: City: State: Zip: Phone: Length at Present Address: Social Security #: Date of Birth: Business Name: Position or Occupation: Business Address: City: State: Zip: Business Phone: Length of Employment: MEMBER FDIC UPDATED 2/2024 STATEMENT
Vested
Other
MEMBER FDIC 555 JEFFERSON STREET / PADUCAH, KENTUCKY 42001 / 270.575.5700 / PADUCAHBANK.COM Page 2 PERSONAL FINANCIAL STATEMENT
ASSETS In Dollars (Omit Cents) If Joint, (Do not include assets of doubtful value) [Individual] with whom
Checking & Savings, CD’s (see Schedule A)
Government & Marketable Securities (see Schedule B)
Securities (see Schedule
Broker In Margin Accounts
Control or Margin Account Stocks
Estate Owned (see Schedule
Loans
Notes Receivable Automobiles
Surrender Value/ Life Insurance (see
SECTION 3: STATEMENT OF FINANCIAL CONDITION AS OF
Cash,
U.S.
Non-Marketable
C) Securities Held by
Restricted,
Real
D) Accounts,
&
Cash
Schedule E)
Interest in Deferred Compensation/Profit-Sharing
(see
Plans
Schedule F)
Property Itemize (see Schedule
if applicable) TOTAL ASSETS LIABILITIESS In Dollars (Omit Cents) If Joint, [Individual] with whom
to Banks & Others (see
Due
Brokers
to
to
Accounts
Bills
Income
Taxes
Interest
Mortgage
(see
NET WORTH TOTAL LIABILITIES AND NET WORTH
Assets/Personal
G
Notes Payable
Schedule H)
to
Amounts Payable
Others-Secured Amounts Payable
Others-Unsecured
&
Due Unpaid
Tax Other Unpaid
&
Real Estate
Payable
Schedule D & H) TOTAL LIABILITIES
INCOME
ANNUAL INCOME Individual Joint (Y or N) Salary, Bonuses & Commissions Dividends & Interest Real Estate Income Other Income (alimony, child support, or separate maintenance. Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.) TOTAL INCOME ANNUAL EXPENDITURES Individual Joint (Y or N) Mortgage/Rental Payments Real Estate Taxes & Assessments Taxes (Federal, State & Local)
Payments
Contract Payments (Car Payments, Charge Cards, etc.) Alimony, Child Support, Maintenance
EXPENDITURES
SECTION 4: ANNUAL
FOR YEAR
Insurance
Other
TOTAL
SCHEDULE A | CASH, CHECKING AND SAVINGS ACCOUNT, CERTIFICATES OF DEPOSIT, MONEY MARKET FUNDS, ETC. (Use additional sheets if necessary)
SCHEDULE B | U.S. GOVERNMENT & MARKETABLE SECURITIES (Use additional sheets if necessary)
SCHEDULE C | NON-MARKETABLE SECURITIES (Use additional sheets if necessary)
SCHEDULE D | INVESTMENTS IN REAL ESTATE (Use additional sheets if necessary)
MEMBER FDIC 555 JEFFERSON STREET / PADUCAH, KENTUCKY 42001 / 270.575.5700 / PADUCAHBANK.COM Page 3 PERSONAL FINANCIAL STATEMENT
Financial Institution Type of Account Owner (J)
Pledged, to Whom? Balance
If
Number of Shares or Are these Registered, Market Exchange Face Value of Bonds Description In Name of Pledged or Held by Others? Value Where Traded
Description/Location Date of Original % Owned Market Value of Present Montly Mortgage Mortgage of Real Estate (J) Investment/Amount By You Your % of Investment Balance Payment Maturity Date Owed to Are these Registered, Method of Number of Shares Description In Name of Pledged or Held by Others? Value Valuation
SCHEDULE E | LIFE INSURANCE CARRIED, INCLUDING GROUP INSURANCE (Use additional sheets if necessary)
SCHEDULE F | VESTED INTEREST IN DEFERRED COMPENSATION/ PROFIT-SHARING PLANS (Use additional sheets if necessary)
SCHEDULE G | LOANS OWED TO BANKS, BROKERS, FINANCE COMPANIES AND OTHERS (MASTERCARD, VISA) (Use additional sheets if necessary)
This information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the surety of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue credit or to accept a surety thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the credit worthiness of the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned.
Signature
MEMBER FDIC 555 JEFFERSON STREET / PADUCAH, KENTUCKY 42001 / 270.575.5700 / PADUCAHBANK.COM Page 4 PERSONAL FINANCIAL STATEMENT
Name of Insurance Company Owner of Policy Beneficiary and Relationship Face Amount Policy Loans Cash Surrender Value
Account Manner of Payout Distribution % Vested Company Name Number (Annuity, Lump Sum, Etc.) Date Beneficiary Amount
Owing to Date of Original Present Monthly Date of (Account Number) (J) Borrowing/Amount Balance Due Payment Final Payment Secured By
Date
Signature (Individual)
(Individual) Date
