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• SBA Form 413 (3-05) Previous Editions Obsolete This form was electronically produced by Elite Federal Forms, Inc. (tumble) t, aUS,� � FN OMB APPROVAL NO. 3245-0188 ;f2�a,1},�� ; EXPIRATION DATE:3/31/2008 'o,�t i PERSONAL FINANCIAL STATEMENT . 1953 s. �V/STBPs U.S. SMALL BUSINESS ADMINISTRATION As of NhozcOn '3i) ,A01t) Complete this form for (1) eachroprietor, or (2) each limited partner who owns 20% or More interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan. Name ��a� ` Business Phone Residence Address \01C`I .19 b11 Residence Phone 77 a Atio$i-OD I9 City, State, &Zip Code pi�l`0_,1 pi 3 4 get Business Name of Applicant/Borrower C\\ ` wt�n) trrtax- \-41,11L.d 'bPa?Q�.r]oc C U. C_. ASSETS (Omit Cents) `i LIABILITIES (Omit Cents) Cash on hand & in Banks $ / 2,, OD (.7 " Accounts Payable Notes Payable to (Describe in Installment Account Mo. Payments Installment Account Mo. Payments Loan on Life Insurance Mortgages on Real (Describe in Unpaid Taxes (Describe in Other Liabilities (Describe in Total Liabilities Net Worth Banks and Others Section 2) (Auto) $ St 3— $ lige Savings Accounts $ / D 7 SOU — $ ) at b, 0O0 -- IRA or Other Retirement Account $ 1, 000 - $ 7, boo Accounts & Notes Receivable $ a`2 9 5 , 600 - Life Insurance -Cash Surrender Value Only. _ .. $ 7 5, DUc) - (Complete Section 8) Stocks and Bonds $ "8' (Other) $ (Describe in Section 3) Real Estate $ / "7 /, ovo - Estate Section 4) Section 6) Section 7) Total $ $ 3/ 000 -" (Describe in Section 4) Automobile -Present Value $ a -2 /, 000 - $ t3 Other Personal Property $ / / 9. 6,v0— $ a 5, Opp — (Describe in Section 5) Other Assets $ -6 $ 1 $' 9, ()a) - (Describe in Section 5) Total $ ' do Gc1 /W $ /, 0 6 a a 00 - $ S'-0 !oU - Section 1. Source of Income Contingent Liabilities Salary $ a As Endorser or Co -Maker Legal Claims & Judgments Provision for Federal Income Tax Other Special Debt $ Net Investment Income $ 0 $ Real Estate Income $ 1 / 0 0 "" $ -43 Other Income (Describe below)' $ / 6 1 a Lal" $ Description of Other Income in Section 1. gae \ , Qc-k.,04.&01.0a Ate -c4 LAN 3 vA-t- LR -s vAxanR,_ 1I 0) a (2 OL) — 'Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income. Section 2. Notes Payable to Banks and Others. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.) Name and Address of Noteholder{s) �riginai a nce Eurrent glance Payment An1'ount Frequency (monthly,etc.) How Secured or ndorsed Type of Collateral R- �►;L9 l.1' P•50 37000- 206e' S-3- . 1, -to co, Las av p ‘,60 v,r)::. b+ rA.tJ ,., "7 z,�� Pi s" —� MY COMMISSISTELLAON EXPIRES: Bondedmiw_ !NSYPubUne�u M. ifHUNTER DD C30d75 January ry 23 Z11Rfd _ I' • SBA Form 413 (3-05) Previous Editions Obsolete This form was electronically produced by Elite Federal Forms, Inc. (tumble)