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federal Reser ve Ba n k o f D allas DALLAS. TEXAS 75222 C irc u la r No. 76-48 March 31, 1976 American Revolution Bicentennial FORM C - 8 , "PERSONAL FINA NCIAL STATEM ENT" TO A L L BANKS IN THE ELEVENTH FEDERAL RESERVE D ISTR IC T: It is the policy of this Bank to fu rn is h our Form C -8 , "Personal Financial Statem ent," free of charge for use by member banks. On occasion, copies are made available to nonmember banks and other concerned p a rtie s , as a m atter of information and use as a guide in p rin tin g a sim ilar form . To be in compliance w ith the provisions of Regulation B, "Equal C re d it O p p o rtu n ity ," we have revised Form C -8 in regard to certain in q u irie s on the statement. A copy of the revised form is enclosed. T h e old form should not be used after June 30, 1976, and any rem aining stock should be destroyed. Supplies of the revised financial statement are availab le to member banks and w ill be supplied upon request to this Bank's Services and B uilding M ain tenance Departm ent or its Branches in El Paso, Houston, and San Antonio. S incerely y o u rs , T . W. Plant F irst V ice President Enclosure This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) Form C-8 Rev. 3*76 Federal Reserve Bonk o f D ollas PERSONAL FINANCIAL STATEMENT -Bank Name_ To l . Address__________________________________________________________________ .__________________________ __ __ — ------------------------- City State Telephone_______________________________________________________________ _ Business or Occupation.______________________________________________ Partner or Officer in any other venture_________________________________ Are any assets pledged?____________________________________________ Have you ever made a composition settlement or taken bankruptcy? Explain*. For the purpose of procuring and maintaining credit from time to time in any form whatsoever 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 condition on the following date, and agree that if 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 notified it may continue to rely upon the statement herein given as a true and accurate statement o f the financial condition of the undersigned as o f the close of business______________________________________________ ____— 19___ payments need not be revealed if the undersigned does not choose to disclose such income in applying for credit. ASSETS Cash on Hand and in Banks (Schedule 1) Income from alimony, child support or maintenance LIABILITIES A N D NET W ORTH $ Notes Payable to Banks — Secured (Schedule 1) Accounts, Loans and Notes Receivable (Schedule 2) Notes Payable to Relatives Cash Surrender Value Life Insurance (Schedule 3) Accounts and Notes Payable lo Others Other Stocks and Bonds (Schedule 4) Rents and interest Due Real Estate (Schedule 5 ) Taxes Due (Schedule 5) Automobiles — Number ( $ Unsecured (Schedule 1) U. S. Government Securities Liens on Real Estate (Schedule 5) ) Other Liabilities (itemize) Other Assets (Itemize) TOTAL LIABILITIES NET WORTH TOTAL ASSETS $ TOTAL LIABILITIES AND NET WORTH CONTINGENT LIABILITIES INCOME Salary $ $ As Endorser or Co*Maker $ On Leases or Contracts Bonus and Commissions Dividends and Interest Legal Claims Real Estate Income Provision for Federal Income Tax Other Special Debt TOTAL INCOME $ INSURANCE COVERAGE Fire Insurance — Buildings Household Effects and Autos Liability Insurance — Automobiles Other Insurance COMPARISON OF M ONTHLY INCOME A N D EXPENSES $ Net Monthly Income Rent or Home Payment $ $ Food and Utilities Personal Incidentals General Public Avg. Amt. Paid on Open Accts. TOTAL EXPENSES DIFFERENCE BETWEEN INCOME AND EXPENSES % 1 $ The Federal Reserve Bank of Dallas does not warrant that this form meets current or future Federal Regulations. We urge you to consult with your bank’s attorneys on future use of this form in its present format or your own revision. (SEE OTHER SIDE) SCHEDULES No. 1. Banking Relations. (A list of all my bank savings and loan accounts.) N a m e a n d lo c a t io n Am ount of Loan C aih Balance $ M atu rity of Loan How En dorsed , G u a r a n t e e d o r Secured $ No. 2. Accounts, Loans a n d N otes Receivable. (A list of the largest amounts owing to me.) Am ount Owing N a m e a n d Address o f Debtor A ge o f D e b t Description o r N a t u re o f D e b t Date P a ym en t Expected Description of Se curity Held No. 3. Life Insurance. N a m e o f Person Insured N a m e of Beneficiary N a m e o f In surance Co. Type of Policy Face Am oun t o f Policy Total Cash Surren der V a lu e Total Loans Against Policy Am ount o f Yearly Premium Is Policy Assigned ? No. 4. O ther Stocks a n d Bonds. Face V a lu e Bonds No. Stock Shares D escription of S ecurity Registered in N a m e o f Cost Present M arket Value Income Received Last Year If Pledged S t a te to W hom No. 5. Real Estate. The legal and equitable title to all the real estate listed in this statement is solely in the name of the undersigned, except as follows:______________________________________________________________________________________________ _____ ___________ Description o r S tre e t No. Dimensions o r Acres I mpr ovements Consist of M ortgages o r Liens Due Dates and Am ounts o f Payments Assessed Value Present M a rke t V a lu e U npaid Taxes Year A m ount The undersigned certifies that the information inserted on each side hereof has been carefully read and is true and correct. Date____________________________________ Signed---------------------------------------------------------------
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