HAZARD INSURANCE PREMIUMSFURNITURE AND PERSONAL PROPERTY46,000HOMEOWNERS ASSOCIATION DUESNET WORTH OF BUSINESS OWNEDRENT OR SPACE RENT1,600OTHER ASSET Cash8,000ALIMONY, CHILD SUPPORT & SEPARATE MAINTENANCETOTAL ASSETS$ 109,532TOTAL LIABILITIES1,600$ 0.00Show any other name under which you have obtained credit: If the answer to any of these questions is "yes" please explain circumstances on an attached sheet1. Have you declared bankruptcy in the last 10 years? __yes _X_no2. Have you had any voluntary or involuntary repossessions within the last 7 years? __yes _x_no 3. Have you had any property foreclosed upon, including deed-in-lieu, within the last 7 years? _yes_x_ no 4. Do you have any unpaid debts with Worth Bank, for any dollar amount, such as accounts which were settled for less than the balance owed or charged off? __yes _x_no 5. Do you have any unpaid debts over $1,000 with any financial institution, including retail cards or student loans, which were settled for less than the balance owed or charged off? _yes _X_noHow do you want to receive the loan proceeds? X Deposit to Escrow Account No._WA6734634RC. Deposit to: __Checking _Savings Account No. _other (describe) To process this application, the bank may require an appraisal and certain property inspections, such as a pest control inspection. However, even if we do not require certain inspections or if we make the loan, it does not mean the property is free of defects or Infestation. The bank assumes no liability for the accuracy of Inspections and makes no warranty of any kind about the condition of the property. You may wish to consult a qualified expert regarding structural soundness, earthquake or slide hazard, toxic substances and other matters related to the condition of the property. By signing below you certify that all the information you've given or will