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CNB Financial Statement
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CNB Financial Statement
Is this a Joint Financial Statement?
(Required)
No
Yes
Click "Yes" if there is a Co-Borrower.
Name
(Required)
First
Middle
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business or Occupation
Employer Name
Length of Employment
Employer Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
Business Phone
Social Security Number
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Co-Borrower Section
Co-Borrower's Name
First
Middle
Last
Co-Borrower's Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Co-Borrower's Business or Occupation
Co-Borrower's Employer Name
Co-Borrower's Length of Employment
Co-Borrower's Employer Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Co-Borrower's Home Phone
Co-Borrower's Cell Phone
Co-Borrower's Business Phone
Co-Borrower's Social Security Number
Co-Borrower's Date of Birth
MM slash DD slash YYYY
SCHEDULE A. CASH IN AND NOTES DUE TO BANKS
(List RE, livestock, equip, & vehicle notes on respective schedules)
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
Name of Bank
Type of Account
Collateral
Deposits
Note Due
TOTAL: Deposits
TOTAL: Note Due
SCHEDULE B. LIFE INSURANCE
(List only those policies that you own)
Company
Face Value of Policy
Beneficiary
Cash Surrender Value
Policy Loan
Company
Face Value of Policy
Beneficiary
Cash Surrender Value
Policy Loan
Company
Face Value of Policy
Beneficiary
Cash Surrender Value
Policy Loan
Company
Face Value of Policy
Beneficiary
Cash Surrender Value
Policy Loan
TOTAL: Cash Surrender Value
TOTAL: Policy Loan
SCHEDULE C. SECURITIES OWNED
(Including US Gov't Bonds and all other Stocks & Bonds)
Description
Cost
AMT Pledged to Secured Loan
Market Value
MKT VAL Not Readily Marketable
Description
Cost
AMT Pledged to Secured Loan
Market Value
MKT VAL Not Readily Marketable
Description
Cost
AMT Pledged to Secured Loan
Market Value
MKT VAL Not Readily Marketable
Description
Cost
AMT Pledged to Secured Loan
Market Value
MKT VAL Not Readily Marketable
Description
Cost
AMT Pledged to Secured Loan
Market Value
MKT VAL Not Readily Marketable
TOTAL: Market Value
TOTAL: MKT VAL Not Readily Marketable
SCHEDULE D. REAL ESTATE OWNED
Description and Location
Date Acquired
MM slash DD slash YYYY
Original Cost
Payment
Maturity
Present Value
Balance Due
Description and Location
Date Acquired
MM slash DD slash YYYY
Original Cost
Payment
Maturity
Present Value
Balance Due
Description and Location
Date Acquired
MM slash DD slash YYYY
Original Cost
Payment
Maturity
Present Value
Balance Due
Description and Location
Date Acquired
MM slash DD slash YYYY
Original Cost
Payment
Maturity
Present Value
Balance Due
Description and Location
Date Acquired
MM slash DD slash YYYY
Original Cost
Payment
Maturity
Present Value
Balance Due
TOTALS: Present Value
TOTALS: Balance Due
SCHEDULE E. LIVESTOCK
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
Type & Description
#
Cost/HD
Payable To:
Total
Loan
TOTALS: Total
TOTALS: Loan
SCHEDULE F. VEHICLES
Make
Model
Year
Payable To
Value
Loan
Make
Model
Year
Payable To
Value
Loan
Make
Model
Year
Payable To
Value
Loan
Make
Model
Year
Payable To
Value
Loan
Make
Model
Year
Payable To
Value
Loan
Make
Model
Year
Payable To
Value
Loan
TOTALS: Value
TOTALS: Loan
SCHEDULE G. EQUIPMENT
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
Description
Payable To:
Value
Loan
TOTALS: Value
TOTALS: Loan
SCHEDULE H. OTHER NOTES AND ACCOUNTS
(Payable and Receivable)
Description
Date
MM slash DD slash YYYY
Notes & Accounts Payable
Notes & Accounts Receivable
Description
Date
MM slash DD slash YYYY
Notes & Accounts Payable
Notes & Accounts Receivable
Description
Date
MM slash DD slash YYYY
Notes & Accounts Payable
Notes & Accounts Receivable
Description
Date
MM slash DD slash YYYY
Notes & Accounts Payable
Notes & Accounts Receivable
Description
Date
MM slash DD slash YYYY
Notes & Accounts Payable
Notes & Accounts Receivable
TOTALS: Notes & Accounts Payable
TOTALS: Notes & Accounts Receivable
SCHEDULE I. PERSONAL PROPERTY, OTHER ASSETS AND LIABILITIES
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
Description
Personal Property
Other Assets
Other Liabilities
Other Liabilities Due in 1 Year
TOTALS: Personal Property
TOTALS: Other Assets
TOTALS: Other Liabilities
TOTALS: Other Liabilities Due in 1 Year
ASSETS (Liquid)
Cash on Hand and in Banks
(Schedule A)
Cash Value of Life Insurance
(Schedule B)
Marketable Securities
(Schedule C)
TOTAL LIQUID ASSETS
ASSETS (Productive)
Securities Not Readily Marketable
(Schedule C)
Real Estate Owned
(Schedule D)
Livestock
(Schedule E)
Vehicles
(Schedule F)
Equipment
(Schedule G)
Notes & Accounts Receivable
(Schedule H)
Personal Property
(Schedule I)
Other Assets
(Schedule I)
IRA & Tax Deferred Accounts
TOTAL PRODUCTIVE ASSETS
COMBINED TOTAL ASSETS
TOTAL ASSETS
LIABILITIES (Short Term)
Notes Due to Banks
(Schedule A)
Notes & Accounts Payable
(Schedule H)
Other Liabilities Due within 1 Year
(Schedule I)
Loans on Life Insurance Policies
(Schedule B)
TOTAL SHORT TERM LIABILITES
LIABILITIES (Long Term)
Real Estate Mortgages Payable
(Schedule D)
Livestock Notes
(Schedule E)
Vehicle Notes
(Schedule F)
Equipment Notes
(Schedule G)
Liens & Assessments Payable
Other Liabilities
(Schedule I)
TOTAL LONG TERM LIABILITES
COMBINED TOTAL LIABILITIES
TOTAL LIABILITIES
NET WORTH
(Assets - Liabilities)
NET WORTH
ANNUAL INCOME
Salary Bonuses and Commissions
Dividends and Interest
Rental and Lease Income (Net)
Other Income
Joint Person's Salary, Bonuses, & Commissions
Joint Person's Other Income
TOTAL INCOME
ESTIMATE OF ANNUAL EXPENSES
Income Taxes
Other Taxes
Insurance Premiums
Mortgage Payments
Rent Payable
TOTAL EXPENSES
General Information
Are any assets pledged other than described on schedules?
Yes
No
Are you a defendant in any suits or legal actions?
Yes
No
Income tax return filed through what date?
Have you ever been declared Bankrupt in the last 10 years?
Yes
No
Are you a partner or officer in any other venture?
Yes
No
Are you an endorser, co-maker or guarantor on any other loans?
Yes
No
CONSENT
Borrower Consent
I agree to the terms below.
This information and the information provided on all the accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this Statement will be relied on by Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the undersigned. Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor's credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of
influencing the actions of Creditor can be a violation of federal law 18 U.S.C. sec. 1014 and may result in a fine or imprisonment or both.
In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a credit report on them. By agreeing to the terms we affirm our intention to apply for joint credit.
The undersigned declares that he/she has read and understands the statements above.
Borrower Consent Date
MM slash DD slash YYYY
Co-Borrower Consent
I agree to the terms below.
This information and the information provided on all the accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this Statement will be relied on by Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the undersigned. Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor's credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of
influencing the actions of Creditor can be a violation of federal law 18 U.S.C. sec. 1014 and may result in a fine or imprisonment or both.
In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a credit report on them. By agreeing to the terms we affirm our intention to apply for joint credit.
The undersigned declares that he/she has read and understands the statements above.
Co-Borrower Consent Date
MM slash DD slash YYYY