Personal Financial Statement

PERSONAL FINANCIAL STATEMENT Date: Submitted To: PERSONAL INFORMATION Applicant's Name Employer Employer's A ddress Business Phone Number Number of Years with Employer Title/Position Name of Previous Employer & Position (if with current employer less than 3 years) Number of Years with Previous Employer Home Address Home Phone Social Security No. Date of Birth Co - Applicant's Name Employer Employer's Address Business Phone Number Number of Years with Employer Title/Position Name of Previous Employer & Position (if with current employer less than 3 years) Number of Years with Previous Employer 2001 251 American LegalNet, Inc. Home Address Home Phone Social Security No. Date of Birth CASH INCOME & EXPENDITURES STATEMENT FOR YEAR ENDED ANNUAL I NCOME AMOUNT ($) Salary (applicant) Salary (co - applicant) Bonuses & Commissions (applicant) Bonuses & Commissions (co - applicant) Rental Income Interest Income Dividend Income Capital Gains Partnership Income Other In vestment Income Other Income (list) Total Income $ Are any significant changes expected in the next 12 months? [ ] Yes [ ] No (If yes, attach information.) ** Income from ali mony, child support, or separate maintenance income need not be revealed if the applicant or co - applicant does not wish to have it considered as a basis for repaying this obligation. ANNUAL EXPENDITURES AMOUNT ($) Federal Income and Other Taxes 2001 251 American LegalNet, Inc. State Income and Other Taxes Rental Payments, Co - op, or Condo Maintenance Mortgage Payments (Residential) (Investment) Property Taxes (Residential) (Investment) Interests & Principal Payments on Loans Insurance Investments (Including tax shelters) Alimony/Child Support Tuition Other Living Expenses Medical Expenses Other Expenses (list) Total Expenditures $ Balance Sheet as of ASSETS AMOUNT ($) Cash in this Bank (Including money market accounts, CDs) Cash in Other Financial Institutions (list) (Including money market accounts, CDs) Readily Marketable Securities (Schedule A) Non - Readily Marketable Securities (Schedule A) Accounts and Notes Receivable Net Cash Surrender Value of Life Insurance (Schedule B) Residential Real Estate (Schedule C) Real Estate Investments (Schedule C) 2001 251 American LegalNet, Inc. Partnerships / PC Interes ts (Schedule D) IRA, Keogh, Profit - sharing & Other Vested Retirement Accounts Personal Property (including automobiles) Other Assets (list): Total $ LIABILITIES AMOUNT ($) Notes Payable to this Bank Secured Unsecured Notes Payable to Others Secured Unsecured Accounts Payable (including credit cards) Margin Accounts Notes Due: Partnership (Schedule D) Taxes Payable Mortgage Debt (Schedule C) Life Insurance Loans (Schedule B) Other Liabilities (list): Total Liabilities $ Net Worth $ CONTINGENT LIABILITIES Are you a guarantor, comaker, or endorser for any debt of an individual, corporation, or partnership? [ ] Yes [ ] No $ Do you have any outstanding letters of credit or surety bond? [ ] Yes [ ] No $ 2001 251 American LegalNet, In c. Are there any suits or legal actions pending against you? [ ] Yes [ ] No $ Are you contingently liable on any lease or contract? [ ] Yes [ ] No $ Are any of your tax obligations past due? [ ] Yes [ ] No $ What would b e your total estimated tax liability if you were to sell your major assets? $ If yes for any of the above, give details: SCHEDULE A - ALL SECURITIES (including non - money market mutual funds) Readily Marketable Securities (including U.S. Governments and Municipalities)* No. of Shares or Face Value Description Owner(s) Where Held Cost Current Market Value Pledged [ ] Yes [ ] No No. of Shares or Face Value Description Owner(s) Where Held Cost Current Market Value Pledged [ ] Yes [ ] No No. of Shares or Face Value Description Owner(s) 2001 251 American LegalNet, Inc. Where Held Cost Current Market Value Pledged [ ] Yes [ ] No * If not enough space, attach a separate schedule or brokerage statement and enter totals only. Non - Readily Marketable Securities (closely held, or restricted stock) No. of Shares or Face Value Description Owner(s) Where Held Cost Current Market Value Pledged [ ] Yes [ ] No No. of Shares or Face Value Des cription Owner(s) Where Held Cost Curren t Market Value Pledged [ ] Yes [ ] No SCHEDULE B - INSURANCE Life Insurance (use additional sheet if necessary) Insurance Company Face Amount of Pol icy Type of Policy 2001 251 American LegalNet, Inc. Beneficiary Cash Surrender Value Amount Borrowed Ownership Insurance Company Face Am ount of Policy Type of Policy Beneficiary Cash Surrender Value Amount Borrowed Ownership Insurance Company Face Amount of Policy Type of Policy Beneficiary Cash Surrender Value Amount Borrowed Ownership Disability Insurance Applicant Co - Applicant Monthly distribution if disabled Number of Y ears covered SCHEDULE C - PERSONAL RESIDENCE & REAL ESTATE INVESTMENTS, MORTGAGE DEBT (majority ownership only) 2001 251 American LegalNet, Inc. Personal Residence: Property Address Legal Owner Purchase Year/Price Market Value Present Loan Balance Interest Rate Monthly Payment Lender Personal Residence: Proper ty Address Legal Owner Purchase Year/Price Market Value Present Loan Balance Interest Rate Monthly Payment Lender Real Estate Investment: Property Address Legal Owner Purchase Year/Price Market Value Present Loan Balance Interest Rate 2001 251 American LegalNet, Inc. Mo nthly Payment Lender Real Estate Investment: Property Address Legal Owner Purchase Year/Price Market Value Present Loan Balance Intere st Rate Monthly Payment Lender SCHEDULE D - PARTNERSHIPS (LESS THAN MAJORITY OWNERSHIP FOR REA L ESTATE PARTNERSHIPS)* Business/Professional (indicate name): Type of Investment Date of Initial Investment Cost Percent Owned Current Market Value Balance Due on Partnerships: Notes, Cash Call Final Contribution Date Business/Professional (indicate name): Type of Investment 2001 251 American LegalNet, Inc. Date of Initial Investment Cost Percent Owned Current Market Value Balance Due on Partnerships: Notes, Cash Call Final Contribution Date *Note: For investments which represent a material portion of your total assets, please include the relevant financial statements or tax returns, or in the case of partnership investments or S - corporations, schedule K - 1s. SCHED ULE E - NOTES PAYABLE Due to Type of Facility Amount of Line Secured [ ] Yes [ ] No Collateral Interest Rate Maturity Unpaid Balance D ue to Type of Facility Amount of Line Secured [ ] Yes [ ] No Collateral Interest Rate 2001 251 American LegalNet, Inc. Maturity Unpaid Balance PLEASE ANSWER THE FOLLOWING QUESTIONS: 1. Income tax returns filed through (date). Are any returns currently being audited or contested? [ ] Yes [ ] No If yes, what year(s): 2. Have (ei ther of) you or any firm in which you were a major owner ever declared bankruptcy? [ ] Yes [ ] No If yes, please provide detail: 3. Have you drawn a will? [ ] Yes [ ] No If yes, please furnish the name of the ex ecutor(s) and year will was drawn: 4. Number of dependents (excluding self) and relationship to applicant: 5. Have you ever had a financial plan pre pared for you? [ ] Yes [ ] No 6. Did you include two years federal and state tax returns? [ ] Yes [ ] No 7. Do (either of) you have a line of credit or unused credit facility at any other institution(s)? [ ] Yes [ ] No If so, please indicate where, how muc h, and name of banker: 8. Do you anticipate any substantial inheritances? [ ] Yes [ ] No If ye s, please explain: 2001 251 American LegalNet, Inc. REPRESENTATIONS AND WARRANTIES The information contained in the statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee 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 guarantee 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 cha