Universal Capital

Please be advised that we are not affiliated in any way with Universal Capital Loans of California

New England’s Premier Hard Money Lender

Short-Term Financing for Real Estate Investments

Loan officer on call this weekend is: Robert A. Edelstein

Personal Financial Statement

BORROWER CONTACT INFORMATION
ASSETS

$ 0.00

LIABILITIES

$ 0.00

SECTION 1.

SOURCE OF INCOME

$ 0.00

CONTINGENT LIABILITIES

$ 0.00

DESCRIPTION OF OTHER INCOME *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)







SECTION 3.

Stocks and Bonds (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed)





SECTION 4.

Real Estate Owned (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed)
Property A.
Property B.
Property C.


SECTION 5.

Other Personal Property and Other Assets (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, describe delinquency)

SECTION 6

Unpaid Taxes (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches)

SECTION 7.

Other Liabilities (Describe in detail)

SECTION 8.

Life Insurance Held (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)
AGREEMENT

I authorize Universal Capital/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).

SIGNATURES


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