Case File
efta-02683508DOJ Data Set 11OtherEFTA02683508
Date
Unknown
Source
DOJ Data Set 11
Reference
efta-02683508
Pages
3
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Bank of
of America
Confidential Personal Financial Statement/Certification as of
2./3 ill
4/
D Joint
The assets, liabilities, income and expenses described on this (or the attached) financial statement are (check the appropriate box):
Individual
If this is an individual financial statement, list all your Income, expenses and assets including your partial
ownership interest in and income from any partially owned assets and fist all of your direct and contingent liabilities.
If this is a joint financial statement, list all of both of your Income, expenses and assets including your partial
ownership in and income from any partially owned assets and list all of both of your direct and contingent liabilities. A
separate Bank of America Personal Financial Statement may be provided for each individual if you prefer.
I (we) understand that the following questions are addressed to me (us) and I (we) have answered them as appropriate.
Yes
No
1. Are you named as beneficiary of a trust, will or estate?
Yes
No
2.
Are any of the assets listed herein held under a trust agreement of any type, held in an estate, or in any other
name or capacity? Please detail In "Additional Remarks" below.
Yes
No
3.
Are any of the assets listed herein on deposit, located, or otherwise held outside the United States of America?
Yes
No
4.
Do any of your assets secure any debts that have not been reported in the following schedules?
Yes
No
5.
Are any of the assets fisted herein located In the community property states of Arizona, California, Idaho, Louisiana, Nevada, New
Mexico, Texas, or Washington?
Yes
No
6.
Are any of your real estate properties used by you in your business?
Yes ___ No
7.
Have you ever filed for personal bankruptcy, had property you owned foreclosed, or made a settlement or an assignment for the
benefit of creditors?
Yes
No
8.
Has any corporation or partnership in which you are (were) a major owner or a general partner overfeed for bankruptcy, had property
It owned foreclosed, or made a settlement or assignment for the benefit of creditors?
Yes
No
9.
Are you, or any corporation or partnerships in which you are a major owner or a general partner, a party to any suit or legal action, or
are there any unsatisfied judgments against you?
Yes
No 10.
Personal income tax returns have been filed through (year)
. Are any income tax returns, whether personal or those of
any corporation or partnership in which you are a major owner or a general partner, currently being audited or contested?
Yes
No 11.
Are you an officer, director, or principal shareholder of a financial Institution?
(we) have explained fully under "Additional Remarks" on this page (or an attachment) my (our) "Yes" answers to the foregoing questions.
Yes
No 12.
I (we) have made a will; the executor(s) is
ddltional Remarks
undersigned (I:We) herewith submit to Bank of America (you) this (or the attached) financial and supporting schedules which constitute my (our) personal
ncial statement This statement is submitted to you for the purpose of Inducing you to extend or maintain credit to me (us) whether as direct obligor(s) or
redly as guarantor(s) or other indirect obligor(s) of credit extended to Others. I (we) hereby certify that this statement presents a hue, complete, and
ect statement of my (our) financial condition as of the date shown and does not omit any pertinent information. I (we) understand that misrepresenting
ration on this (or the attached) statement is a criminal offense under federal law.
*will notify you promptly In writing of any material unfavorable change in my (our) financial condition. In the absence of such notice, you may consider
a continuing statement and substantially correct. If I (we) apply for further credit, this statement shall have the same force and effect as if delivered as an
'nal statement of my (our) financial condition at the time I (we) request such further credit. You are hereby authorized to contact credit reporting agencies
other sources for the purpose of verifying any information stated herein or at any time are authorized to answer any questions about your credit
Mence with me (us), and fumish to Bank of America or any of its subsidiaries information which I (we) have provided to you and information regarding any
y (our) accounts.
ature
Date
Signature
Date
EFTA_R1_02000838
EFTA02683508
in ace'
Balance Sheet
Assets (omit cents)
LiabRities (omit cents)
Page 2
Cash
(Schedule 1)
Securities
(Schedule 2)
Accounts Receivable/Notes Receivable (Sch. 3)
Net Cash Value Ins. & Annuities (Schedule 4)
Real
Estate
(Schedule 7)
Other Partnership Interest
Equipment & Other Business Assets (Sch. 8)
Deferred Comp & Retirement Plans (Sch. 5)
Other Assets (Itemize on pg. 1 or attach)
In this Bank
In Other Institutions
Marketable
Not Publicly Traded
Mortgages
Payable
(Schedule 7)
Notes
Payable
(Schedule 6 & 8)
Taxes
Owing
Printery Residence
Other Wholly-Owned RE
Partially Owned RE
Pdmary Residence
Oth Wholly-Owned RE
Partially Owned RE
To this Bank
Other Notes Payable
Margin Account
Income Taxes
Other Taxes
Unrealized Asset Apprec.
Estimated Credit Card Balance
Accounts Payable
Other Liabilities (Itemize on page 1 or attachment)
Total Liabilities
Net Worth (Assets Less Liabilities)
Iieuucuuus. arare rorar amount by 1 ype of Liability and Provide Appropriate Detail In The Space Below.
Contingent liabilities are financial obligations of other individuals, partnerships, or companies which you have endorsed, guaranteed or otherwise agreed to
or have a statutory obligation to honor in the event of certain contingencies and any direct obligations that are not reflected In the balance sheet above that
you will be required to honor in the event of certain contingencies. These include obligations to Bank of America as well as to other banks or creditors of
any kind. You must disclose all such guarantees, endorsements, etc. in this schedule.
1. As Guarantor or Endorser
3. Legal Claims or Judgments
5. Standby Letter of Credit
2. On Leases or Contracts
4. Income Tax Claim or Dispute Amount
6. Other
Type
e
Name of Primary
"
Obit! or
Due To
Max. Legal
Obligation
Amount
Maturity
Explanation: Include whether you
anticipate having to honor this
lability.
.....
—
-
i
-
i
I
,
..
•
NOTE THAT LEON D. BLACK PURSUANT TO ESTATE PLANNING ENTERED INTO VARIOUS TRANSACTIONS WITH FAM LY TRUSTS AND
GRANTOR RETAINED ANNUITY TRUSTS. THESE TRANSACTIONS GIVE RISE TO RECEIVABLES AND PAYABLES BY LEON D. BLACK TO
FAMILY GRANTOR TRUSTS FOR WHICH LEON D. BLACK IS GRANTOR FOR INCOME TAX PURPOSES. 711ESONTRA.FAMILY TRANSACTIONS
[
ARE ZERO SUM TRANSACTIONS AS ANY RECEIVABLE IS Et:WALT° A PAYABLE. FOR REPORTING PURPOSES. THESE TRANSACTIONS ARE NETTED.
•
t
i
'
'I
i
I HAVE NO CONTINGENT LIABILITIES
knnual Income/Expense Information
renany. Child support or Separate Maltnanise Income need not be revealed unless you rash to hay them considered as a bias forrepafdtg the requested am%
sources of Cash
Last Year
19_
Projected This
Year 19_
Uses of Cash
Last Year
19_
Projected this
Year 19._
Meaning
Expanses
alary & Wages
Income Taxes & FICA
:ommissions, Bonus, Etc.
Other Payroll Deduction
Retest & Dividends
Living Expense, Misc.
eat Estate Income
Real Estate Expense
rust Income
Planned Investments
ther Business Income
Alimony, Child Support, Separate Maid.
then
Other:
Sub Total
Sub Total
on-Recurring
Debt Service
ommissions, Bonus, Etc.
Primary Residence Pmt.
ate of Assets
Scheduled Principal & Int.
IX Refund
Other Interest Pmts.
ther
Other Principal Pmts.
Contingent Liability Pmts.
Total Cash Uses
Total Cash Sources
Total Cash Flow
EFTA_R1_02000839
EFTA02683509
EFTA_R1_02000840
EFTA02683510
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