Date. 



Appraised by: 



Name , Title 



tDescribe existing liens, if any, on property Hated above. Attach photograph of property if available. 



9. Financial statement as of .- , 19 , fiscal year ends _ 



(Statement must be dated within 60 days of the filing of this applicatiov. Omit $.00) 



(The applicant may submit in lieu of the financial statement prescribed below, a copy of a statement dated within 90 days of 

 the filing of this application provided he also supplies the supplementary detail called for on items marked with an asterisk.) 



ASSETS 



LIABILITIES 



Cash on hand and in banks 



•Notes receivable 



•Accounts receivable $ 



Less reserve for doubtful 



accounts - 



Inventories (in4iicate kind and 

 valued) : 



how 



•Other current assets 



Total current assets 



•Due from affiliates or subsidiaries 



•Due from officers, directors, and stock- 

 holders 



Life insurance (CSV) 



Land 



Buildings $ 



Vessels and gear 



Machinery and equipment 



Furniture and fixtures 



Autos and trucks 



Less reserve for deprecia- 

 tion 



•Other assets 



Total assets 



•Notes payable to vendors 



•Notes payable to banks 



•Notes to officers, directors, and stock- 

 holders 



•Notes to others 



♦Accounts payable to vendors 



•Accounts due officers or stockholders. . . . 



Income taxes 



Other accruals 



•Other current liabilities 



Total current liabilities 



•Mortgage debts 



•Other liabilities 



Total liabilities 



Capital stock f 



SuiTjlus and undivided 

 profits 



Capital account (if individual or part- 

 nership) 



Total liabilities and net worth. . . . 



'Itemize on a separate sheet all items marked witil an aateriak. If any of the liabilities shown in the above financial statement are secured, state the amount 

 and to whom owed and itemise collateral pledged as security. iSes Inatruetions.) 



CONTINGENT LIABILITIES: Accounts or notes receivable discounted or sold with endorsement or guarantee and all other contingent liabilities, including 

 t«rms of any leases, should be explained on a separate sheet. Also, describe any pending or imminent litigation. 

 NoT& — Submit copy of last available audit or of financial statement at close of last fiscal period (i/ eucfc dair differs from daU of above statement). 



le— 72847-1 



