Loading...
HomeMy WebLinkAboutSue CREDIT R • IMPORTANT APPLICANT INFORMA-MR: Federal law requires financial Institutions to obtain sufficient information to verity your identity.Ycu may be asked several qua ons and to pmvideione or more forms of identification to fulfill this requirement,in some instances we may use outside sources to Confirm the,information.The information you provide is protected by our pdvacy policy 4nd federal law. TYPE OF CRE T QUESTED '' ✓I �� ::I Secured Unsecured Date of Application f0 Citizens State Bank NYA KIndividual Credit-relying on my income or assets. ATTN:LOAN DEPT Amount$ dd wLon ndividual Credit-relying on my income or assets P.O.BOX 769 Payment Desired 3 1 d013 as wen as income or assets from other sources. NYA,MN 55366 Want to Repay ❑Monthly ❑ Joint Credit-Weintend to.apply-for joint credit. Purpose t (initials) LENDER'S NAME AND ADDRESS Acct.No. Class Pi*44111[11111111012111111 a' /' • LAST FPST M.1. /� -i 7' '� �J Name A 5 Birth Date ca-� Tel.No."(5�- �( -��'y Sec.Sec.No.-`7� Present Address "L Z-f nnina-uLn t) city � (stale_� Sip=.55 3�?w County How Long Previous Address 3 tI " ; c--11 City�?1,4 Ta�u,Fy�—yY�.1—a_Zip Jr,J�I X07 County_(n Ll.lY�Yq.r How Long Have you applied for credit with us before? ❑.No Yes-When? / �f.Lf f V"D' �G?�i�\t5'0VV 5No.Dep._S!Dep:Ages Name of Ne st Relative Not Living With You - u `` C �� Relation shi Address attfry1 V ill_ � h!11 f rnh ��Qr Tel.No. Employer(Company Name y&Address) f�� s How Long r `p Bus.Tel f��4�_r Poshion,'Tide + ,A T m 1 IN §V N61 Often Paid? Y aka Home Salary Per Month r C u* Previous Employer(Company Name&Address) n t jq of 06 hi-6!`(((rill. How Long Alimony,child support,or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony,child support,separate maintenance received under: ❑Court Order ❑Written Agreement Ll Oral Understanding Sources of Other Income Amount Per Month$ Complete only fF for joint credit,for individual credit relying on income or assets from other sources,or applicant is married and resides in a community property state. LAST FIRST M,I. Name _._......_Birth Date Tel.No. Soc.Sat..No. _ Present Address ___.- City State Zip County How Long Relationship To Applicant(If Arty) Have you applied for credit with us before? ❑No ❑Yes-When? No.Dep. Dep.Ages Name of Nearest Relative Not Living With You Relationship Address — Tel,No.( ) ...._.._.._..... Employer(Company Name&Address) How Long Bus.Tel. PositiortTitle How Often Paid? Take Home Salary Per Month$ Alimony,child support,or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony,child support,separate maintenance received under: ❑Court Order ❑Written Agreement ❑Oral Understanding Sources of Other Income Amount Per Month$ a Complete only it forjointAor secured credit,or applicant resides in a unity property state or is won property located Ssu h3 rate. Unmarried gie uwcrced a u rt w�:n}� PP ❑Bdanisd [IS epara rttna - Odw ©Maarrietl If Section B has been comppleted,this Section should be completed giving information about both the Applicant and Joint Applicant or Other Person.Please mark Applic xnt-related information with an"A.'If Saction B was not completed,only give information about the Applicant in this Section. ASSETS OWNED(Use separats sheet it nscessa . T DESCRIPTION OF ASSETS NAME IN WHICH THE ACCOUNT IS CARRIED a0� chec kng Account N mber(s). l j/ Q D 3+>ZfS C 4u oil V� t� $ _W (where)re) P u i at I Saving)Accou N bar( 'ni of 5 �A FF,Azie (where) S ik lnp Cr 3ei ,n t s Other Asts &Lr pV✓5-- L A4,n V[L (describe) TOTAL ASSETS OUTSTANDING DEBTS (include charge aocourds,installment contracts,credit cards,rent,mortgages and other obligations.Use separate sheet it necessary) C CREDITOR ACCOUNT NUMBER NAME.THE ACCT.IS UNDER ORIGINAL AMT. I PRESENT BAL. MO. PMTS.. • I n� ❑Rent Payment (OMIT RENT) (OMIT RENT; landlord or /v y( � Mortgage Holder ❑Mo triage $ �- $ $ Automobiles J,nka model, arl /ty t� _ _ (Z/0Jaded) WPZSOE/9 SMOJVOn--;I NI NIV-10'1S'-l'awatei8waxueg99610 Kea (aIgm!ddy WOW)alnt-aufi!S Je410 also a3meu6!S que 1 9 1i -sa eUO p!puoo le!O� y Aw 1!lsanbeJ s.J 1 uoyewa u 3l lepdn lsnw i le1;l puelsJappurt!'uepuaq 43!m p1oOaJ iiOaJO Aw lnoge Japua-!>,se Aew sJaylo suo!isenb Jamsua Ol pue ols!4 luauJAo!dwa Due l!paJO Aw ayo 01 Japua�az!JO l nw!aq 6u!u6!s Ag'PaAOldda 3111 IOUJO Jaglaym uopeaydde s'up da.,Aew Japual wanco sr sluawgoeUR Aue uopue uoRe3!l de s!UI ut patois aneq i 6u!y ana lew Aiwoo I•smmvNO3s -------- :(Aue 1!)asnods JnoA to aweUynt aL4 an!8'alelsa teal s!Alpmes Rip 11 ' :Ayadwd syilo sJaumo-oo IIe.10 sassalppy g saweN - -"........_.":u04)dp3990 AyadOJd ;saJelUI d 4MUMMO ue aney SJeyio R alea!PUI:PUS AWnOas se ua46 eq of Apadoid a41 ogposap Altaug pamcas aq cl s!1!peju 11 filuo alaldwop m • i M i)eaA- LaaUm'saA}! sa4-%oN❑ AsJeaA p 1 Isel out u!ldnaiiueq paaepap uaeq noA aneH S wnoLuV-_ •✓ Apamo wo4m of'saA ll saA❑O/N{��-�'4W Isu!e6e sluetw6pnl pags!lesun Aue army aJy Lwoum 01 If"JO{'saA 11 saA Q ON. kpeJluoo J4 ueol Aue up JolueJen6 z'Jeslopua'JaxeWCO a no4 aJy $uwcyy Jad lunculy (ssaappy g awaN)01 saA t! D L i� 1 �b hr- sa� ONE] isluawAed aoueuelweyq Jo uoddnS'Auowpy eXuw of pele6!igo no1A..,siV SPA :{a!q /� as Aaw lu dy aUl Uloq lnoge uoyeuuotu!6uwcxlot ayt al Nii-\kpq f _ a ; 3 slg3o�ylol� -*L-$ <;o'S t° 00 ?SL "XWT2f 19 -n Q tQe ...__0QL C�6Yl / $ 9 OhIq r/ G� W-25DS 14M 04-41 000 b Oea,.lop-ox-)saligouotoV F-1 PIOH 0964JoW (1NSIS 11W0) (1N3H 11W0) luauJAed luaH �V JO pto!puB't 'S1N1d'0W 'WS1N3S3!!d '1WVIVNIMHO H3NNns1'mav JAI 3WVN H38WnN1Nn0OOV AJessaOau{!laa4s a;eledas asn'suo!1e6!tgo Jayio pue s e ow'lua:'spJSO I!par„•s;OeJ3uO3 wau:pasu!'slan030e a Jeuo apn!oul) S183G 0NIQNVISln0 __.. ! S135Stl 1tl101 (aquoseP) �p� � ��n t.c/Yz1!rJ,5'S� siassy JsylO Cd iaJauml �� ✓�v S��(�'7 1 rLI (s)Ja4 ItN unOOOV SW!naS N'y GV'-L "'V✓ -WJfjp _XL? 1•,�,� In of (s)Jagw N 3uncoDV Our lOa40 _,C 11&4) Lots. 03!H5yo si 1Nn000V3H1 HO1HM NI 3WVN S13SSY 30 NOUMHOS30 n 03303011ll taey°s ala e-c as ash O3NMO S13S$V vagOaB slut ut weOyddy a4l1noge uoyeuuatu!a..,46 A!uo'pola!dwoogou sam g uoyoeS 11.V.US U31m uoyavuclu! Petepi-woonddy>uaw 8se8id'uOSJad J9LpQ JO lueoliddV w!of ptm weo!3ddV out uloq lnoge uO)tauJJolui buwd pe!aidwoo aq piny s uO!lOeS s!ul'Pilot ddLU00 usaq seu 8 u0g0as U • .♦ • 0100,03S .paUJewun paeJedeS E] pawey�! ] AtJed.10410 ,Pe!uewu jwedaS[] pauJe!ry❑i lueOlpdy (par..p!.:1 pup peoJO.p•a!Bwt sap.pw.,) •aleis a eons ul palwxi AUedcud ua 6u!AtaJ s!Jo alels AUedoid Apun oO a u!seplseJ waollddu Jo ylpsio paiwas Jo w!ol Jot:1!i4uo alaldwoo rA $WuON Jad lunowy eUJO3ul JaUl01a saOMOS Ou!pueisJapun IeJO❑ luawooXv ualtuM❑ JapJo UnOO F :Jepun panleaaJ aausuaiu!ew aleJedas'lroddns pl!4o'Auow!IV •uo!IRSIIgO s!41 6u!Aedai Jot s!seq a se paJap!suOD t!aney Ol ys!m lou op noA g poleenaJ eq tou paau awoou!eoueuelu!ew eleJedos Jo'poddns pl!yo'Auowlly s Uluotry Jed A,eteS auoH aNg-L ipled u8310 mOH all!yuoy!sod -191'sng --'—'.'6u0-1 IOH (ssaJPPV V awaN Aueduroo)Woidw3 -ON-101 sesipptl -' dutsuoyelay noA 43!M 6u!An 3oN anye!aa ISGJe6N 1O aweN sa6tl'deo -da0'ON LuayM•saA L] ON Lj Lwotaq sn 4Y.m 31paJO Jot peydde noA aneH (Autl 11).lueogddV o1 d!ysuo!le!ay ---"-CU01 r.:o1{ punoo d!Z aims A4!0 - 9sauppy luescud 'ON'In'wS 'oN'IRl 0100 UU!S..._ aweN 1'W Jatw JSYi 'aiels 4000Jd At!ununuco a u!sap!saJ PUS pawew sl 3ueoydde uo'ascunos Jaylo woJ1 slasse Jo awoou!uo OU!AleJ gp9jOlWgAJpu1 Jo1'UPeJo dluojJol 4 Aluo alaldwo0 $giucyy Jad wnowV - eumul Joilto 10 saalnos 6uwue3sispun!aJo n luawoejOV ueupm a JapJO vnoO.n ;Japun PaAIOOOJ ooueuelulew aleJedas'Uoddns pl!Llz,Auow!IV •UO!te6!lgo s!yl 6u!Aada Jo;sseq a se paiap!suaO i!aney of gsaw IOU op nOA 11 paieanOJ aq toy paau awoou!aoueuatu!ew aMucclas Jo'lJoddns pl!4*'Auow!IV L 1 $ 6uo-!MOH issaJppy g aweN Auedwo0)lado!dw3 sn0!AaJd $4luOW Jac!NeleB awoH a e LP!ed ua4p r' OUJsvog!sod a1'sng l►� ..r`x�3M- mq§jA5 u,w �vt ";j"(� 4118 -fib J 6uo-1 -OH ''T'r+— 5 �` Lfd y--��--•- (asaJppy aweN Auedw00)Ja4oldw3 c /-C- aN'lal 'I!•�C�S L1W_ V1, ( 1- ssaJPPV !ysuOye!aH - 1 a p ra noA ullM 6u!nrt ION ann0iay is eN 10 aweN sa6V•dap TS—'da0'ON5 �•S )�� _,V i,uaUM A: ON.❑ Lexgeq sn yum J!paJ3 Jol papdde noA aneH &JO MOH 4// Aiun d Al! 9$0JPPV snO!naJd SJ °� L9ec'+--5 2�� rx� l� �PBt s 1 oJa L 6uoq mo Aiuno drl elms Al!0 � ssaJppV WasaJd le 2!+(119 U U�7tiUVl^Z ib •oN•Oa8.308 oN'lal RISC Up!g— aweN E°1�91-h9 Ct h S 8�S�45h ��� jzkmj i vo �n N0lIVW80zINl iNvon4dy-tynowa 01103S SaetO 'ON.IO, S931100V QNV 3WVN SAMON31 (sle!l!u!) asodJnd 'i!pom lu!ol Jot-Aidde of puaiu!am,upolo war 1� .-Igytuoyd b Aetl-Hot iueryl $9£S9 NIN VAN •saOJnosJa4lo woJl siosse JO aWO3u!se lam so paJ!sa0 aie0luew4ad 682 X08 O d slasse Jo awoou!Aw uo 6wAla.-3!peJO!enpin!pu! 0.1 m QD $lunowy ld30 NVOI:Nlld 'slasse JO awoou!Aw uO 611!4}81-3!PSJO lenP!n!PU �'.. uoyeoyddy�aie0 VAN NUEB OMS sua2110 pwnoasul pwn3aSC do3dAa •mei leJapat pu Aoliod/oen!Jd Jn0 Aq palaa)oJds! ap!noid no4 uoyeuuolui ayl uogew101u!ayl wJyux of seoJnos ap!slno asn Aew am saouelsu!suds u!yuawannbw s!ui lIgInl of uo!le0yyuap!10 suuOl aJow Jo auo ePlno,d of Pua suOrlsanb ieianas paxse aq Aeu,noA'Alquap!JnoA/yuan of uoptuiow!)u0!owns u!elgo at suognt!law le!oueuy sannbaJ mat 1eJapaj :N0!1VWHOdNI 1NVOP1ddV 1NVJ.HOdwi N0IIV3IIddVIICI3H3