05-16-1979 Council Agenda - Laserfiche WebLink

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Name Ni ehnl as Capetz Addr uf► For the purpose of procuring and maintaining credit from time to time in any form whatsover with the above named Bank, for claims and demands against the undersigned, the undersigned submits the following as being a true and accurate statement of its financial con- dition on the following date, and agree that 0 any change occurs that materially reduces the means or ability of the undersigned to pay all claims or demands against it, the undersigned will immediately and without delay notify the said Bank, and unless the 'Bank is so noti- fied it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the under- signed as of the close of business. (Month) December (Day) 1978 ASSETS LIABILITIES Cash on hand and in Banks $ 17 500 00 Notes payable to Banks Secured Libert)r 9t $at't 25_ 000 00 U. S. Gov. Securities —see schedule Listed Securities ---see schedule 3 f)f)f) 0 Unsecured Notes payable to relative. Unlisted Securities —see schedule Accounts and Notes Receivable Due from relatives and friends 2 000 Notes payable to others 00 Accounts and bills due Accounts and Notes Receivable Due from others —good 25 6 000 500 00 Accrued taxes and interest OO Other unpaid taxes 181 000 00 Accounts and Notes Receivable Doubtful 50 000 00 Mortgages payable on Real Estate —tee schedule Real Estate owned —see schedule 385 000 00 : Chattel Mortgages Real Estate Mortgages owned* 30 11 000 000 00 00 and other Liens payable Other debts— itemize Automobiles Personal property 20 O00 00 Other assets— itemize Life Ins. Cash Surrender Value Total Liabilities 906 000, 00 NET WORTH 344 000 00 TOTAL ASSETS $550_ 000 _00 TOTAL LIAB. H NET WORTH 1550 000 00 *C /D - 6/1/79 SOURCE OF INCOME PERSONAL INFORMATION Salary $ Business or occupation Age Real Estate Agent 57 Bonus and commissions $ 5 000.00 Dividends $ Neri i gi bl e Partner or officer in any other venture Real Estate income $ 16.000.00 Other income — itemize (Spouse) $ 12 000.00 Married X Children 3 Single Dependents 3 TOTAL $ 33,000.00 CONTINGENT LIABILITIES GENERAL INFORMATION As endorser or comaker $ No Are any assets pledged? No On leases or contracts $ No Are you defendant in any suits or legal attions? No Personal bank accounts carried at Minnesota Federal Legal claims $ No Provision for Federal Income Taxes $ Yes Other special debt $ No Have you ever taken bankruptcy? Explains No (SCHEDULES ON REVERSE SIDE) U(3