CONFIDENTIAL

PERSONAL FINANCIAL STATEMENT

Statement Date: 07/08/2020

Personal Information

Name: Talisa Medina SSN: 196-56-4397

Address: 2518 N 108th Drive Birthdate: 05/23/1975
City, State Zip: Phoenix, AZ 85392 Dependents: 04
Home Telephone: (213)373-9830 Business Telephone: (703)908-5702

Section I
ASSETS LIABILITIES
1 Cash on Hand & in Banks $8947.00 21 Notes Due to Banks $4095.00
2 Cash Value of Life Insurance $12030.00 22 Notes Due to Relatives & Friends $697.00
3 U.S. Gov. Securities $3494.00 23 Notes Due to Others $359.00
4 Other Marketable Securities $4553.00 24 Accounts & Bills Payable $569.00
5 Notes & Accounts Receivable – Good $14957.00 25 Unpaid Income Taxes Due - Federal State $420.00
6 Other Assets Readily Convertible to Cash – Itemize $2248.00 26 Other Unpaid Taxes & Interest $134.00
7 27 Loans on Life Insurance Policies $1283.00
8 28 Contract Accounts Payable $935.00
9 29 Cash Rent Owed $1346.00
10 TOTAL CURRENT ASSETS $46229.00 30 Other Liabilities Due within 1 Year -Itemize $108.00
11 Real Estate Owned $22000.00 31
12 Mortgages & Contracts Owned $10384.00 32
13 Notes & Accounts Receivable – Doubtful $5537.00 33 TOTAL CURRENT LIABILITIES $9946.00
14 Notes Due from Relatives & Friends $1027.00 34 Real Estate Mortgage Payable $3500.00
15 Other Securities - Not Readily Marketable $2304.00 35 Liens & Assessments Payable $2390.00
16 Personal Property $98450.00 36 Other Debts - Itemize $1458.00
17 Other Assets – Itemize $9068.00 37
18 38 TOTAL LIABILITIES $17294.00
19 39 Net Worth (Total Assets - Total Liabilities) $177705.00
20 TOTAL ASSETS $194999.00 40 TOTAL LIABILITIES & NET WORTH $194999.00

ANNUAL INCOME ESTIMATE OF ANNUAL EXPENSES

Salary, Bonuses & Commissions $89900.00 Income Taxes $7750.00
Dividends & Interest $13020.00 Other Taxes $5650.00
Rental & Lease Income (Net) $9800.00 Insurance Premiums $5495.00
Other Income - Itemize $7870.00 Mortgage Payments $4656.00
Other Persons Salary, Bonuses & Commissions $0.00 Rent Payable $6733.00
Other Income of Other Person - Itemize $0.00 Other Expenses $2800.00
Total $120590.00 Total $33084.00

Section II
A CASH IN BANKS AND NOTES DUE TO BANKS
COLLATERAL (If any)
Name of Bank Type of Account Type of Ownership On Deposit Notes Due Banks & Type of Ownership
South State Bank Savings Individual $15058.00 $756.00
Cathay Bank Savings Individual $10384.00 $432.00
Old National Bank Savings Individual $32038.00 $908.00
CIBC Bank USA Checking Individual $5005.00 $234.00
MUFG Union Bank Savings Individual $9084.00 $0.00
Valley National Bank Checking Individual $1937.00 $0.00
Cash on Hand
TOTALS $73,506.00 $2330.00

PERSONAL FINANCIAL STATEMENT

 CONFIDENTIAL

SECTION II (Continued)
B LIFE INSURANCE (List only those Policies that you own)

Cash Policy Loan Other Loans

Company Surrende from Policy as
Face of Policy BENEFICIA
r Value Insurance Collateral RY
Co.
Securian Financial $6566.00 $12035.00 $10000.00 Vehicle 1 Melissa Raffensperger
John Hancock $9096.00 $18037.00 $18262.00 Vehicle 2 Miguel Medina
Insurance
Haven Life $10938.00 $32000.00 $15739.00 Home Patricia Chapin
USAA Life $25850.00 $9374.00 $9038.00 Garden Rocky Medina
Insurance
TOTALS $71446.00 $53039

C MORTGAGES AND CONTRACTS OWNED (Indicate by X if Others have an Ownership Interest)

Contract Mortgage X Maker Name Maker Address Property Covered Start Date Payment Maturity Balance Due
Primary Residence $200000.00 Arthur Medina 11106 W Turney Ave Apartment 12/20/2017 $137633.00 Clear $62367$
Phoenix AZ 85037

TOTALS $62367$

D PERSONAL PROPERTY (Indicate by a X if Others have an Ownership Interest)

DESCRIPTION X Date When Cost When Value Today Balance Due To Whom
New New Payable
Primary Residence 12/20/2017 $200000 $265000.00 $62367$ Jeremy Lansford
Vehicle 1 06/03/2018 $15000
Vehicle 2 09/12/2019 $10000

TOTAL $290000

For the purpose of procuring credit from time to time, I/We furnish the foregoing as a true and accurate statement of my/our financial condition.
Authorization is hereby given to the Lender to verify in any manner it deems appropriate any and all items indicated on this statement. The undersigned also
agrees to notify the Lender immediately in writing of any significant adverse change in such financial condition.

Signature: Signature: Date:

PERSONAL FINANCIAL STATEMENT