DATE:_______april 9 2009_________________ REFERRED BY: __carl smith______________________ NAME: _________carl smith__________________________________________________________ SOCIAL SECURITY #:___186457____________________ CO-BORROWER’S NAME:_____(none)_________________________________________________ (If Applicable) CO-BORROWER’S SOCIAL SECURITY #____(none)______________________________________ BORROWER’S ADDRESS: _________(none)____________________________________________ DAYTIME PHONE:____124456___________________EVENING PHONE:_____124456________________ CELLULAR PHONE: ____________124456__________ BEST TIME TO CALL:___________when im in town______________________________________________ Borrower’s annual income (before taxes): ________________ Co-borrower’s annual income (if applicable): _____(none)____________ Total monthly credit card/loan payments: __$100_______________ (Minimum required payments please. On loans other than credit cards, eliminate payment if 8 or less payments remaining.) Are you borrowing to: □ (whatever you are buying):_____i am useing it to help with some financhal needs_____ How much money are you asking to borrow:_____4k______ ___________________________ Notes, if needed:________________________________________________________________ ______________________________________________________________________________ Signature(s):___Carl Smith_____________
_________________ name kman smith current job pizzaboy stat: dead
Carl Smith job: runing kmans pizza in kmans honer stat: dead Jon smith missing saji smith stat: dead Jake Smith status:alive
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