ANBp.4

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1 Confidential Stat Financial ement as of __________________ NAME SS# DOB NAME OF SPOUSE (if married) SPOUSE SS# # OF DEPENDENTS ZIP ATE HOME ADDRESS CITY HOME PHONE ST YRS BUSINESS PHONE BUSINESS ADDRESS EMPLOYER POSITION SECTION 1 BALANCE SHEET (OMIT CENTS) LIABILITIES (OMIT CENTS) ASSETS in Credit Union Union Square CASH MORTGAGES Homestead Wichita Falls, Tx. (Schedule 1) PAYABLE In Other Institutions Other Wholly-Owned R/E (Schedule 7) Partial Ownership in R/E Marketable SECURITIES (Schedule 2) Credit Union To This Not Publicly Traded NOTES PAYABLE Other Notes Payable RECEIVABLE ACCOUNTS OIL & GAS RELATED DEBT (Schedule 8) (Schedule NOTES RECEIVABLE 3) (Schedule 4) NET CASH VALUE OF INS. & ANNUITIES Income Taxes TAXES OWING Homestead Other Taxes REAL ESTATE Other Wholly-Owned R/E ACCOUNTS PAYABLE (Schedule 7) Partial Ownership in R/E ESTIMATED CREDIT CARD BALANCE OTHER LIABILITIES (Itemize on Page 4) (Schedule 8) OIL & GAS INTERESTS EQUIPMENT & OTHER BUSINESS ASSETS (Schedule 5) DEFERRED COM. & RETIREMENT PLANS PERSONAL PROPERTY & AUTOMOBILES TOTAL LIABILITIES (Itemize on Page 4) OTHER ASSETS NET WORTH (Assets Less Liabilities) TOTAL ASSETS TOTAL LIABILITIES & NET WORTH SECTION 2 CONTINGENT LIABILITIES no Do you have any contingent liabilities? yes If yes, give details in Section 9 SECTION 3 INCOME / EXPENSE INFORMATION THIS YEAR LAST YEAR PROJECTED NEXT LAST YEAR PROJECTED NEXT SOURCES OF CASH USES OF CASH __________ __________ __________ __________ __________ (See note 2 on page 4) DATE DATE DATE DATE DATE INCOME TAXES & FICA SALARY & WAGES COMMISSION, BONUS, ETC. OTHER PAYROLL DED. GNIRRUCER SESNEPXE INTEREST & DIVIDENDS LIVING EXP. & MISC. RENTAL INCOME RENTAL EXPENSES OIL & GAS CAP. EXPEND. OIL & GAS REV. AFTER OP. EXP OTHER BUSINESS INCOME OTHER BUSINESS EXP. OTHER: OTHER: .DETELPMOC EB TSUM 3 DNA ,2 ,1 SNOITCES SUBTOTAL SUBTOTAL COMMISSIONS, BONUS, ETC. REG / SCHED. PMTS. GNIRRUCER-NON ECIVRES TBED OTHER INTEREST SALE OF ASSETS OTHER PRINCIPAL TAX REFUND CONTINGENT LIAB. OTHER: TOTAL CASH USES NET CASH FLOW TOTAL CASH SOURCES The above financial and supporting schedules, which are submitted to you for the purpose of obtaining credit from you, present a true, complete and correct statement of my financial condition as of the date shown. I understand that misrepresenting information on this statement is a criminal offense under federal law punishable by a fine and/or imprisonment. I will notify you in writing of any material unfavorable change in my financial condition. In the absence of such notice, you may consider this a continuing statement and substantially correct. If I apply for further credit, this statement shall have the same force and effect as if delivered as an original statement of my financial condition at the time I request such further credit. You are authorized to contact my appropriate third parties for the purpose of verifying any stated information herein or at any time furnished by me to you, and obtaining credit information at any time from any of my creditors and or credit reporting agencies. This financial statement and any other information furnished to you shall be your property. You are authorized to answer questions about your credit experience with me. WITNESS _______________________________________________ DATE _____________ SIGNATURE ________________________________________ DATE ______________ OFFICIAL USE: Loan Officer Review _____________________________________________ Credit Dept. Review _______________________________________________

2 Schedule 1 – Deposit Accounts Name & Location Where Held Type of Account Acct. No Restricted Y/N Balance Style of Account other institu t ions Total Total this bank Stocks and Bonds Schedule 2 – Shares Registered Where Market Restricted Market Pledged Issuer Name of Cost Yes/No Yes/No per Share Value or Par in Name Of Traded Total Marketable Total Not Traded (Restricted means trading of the security is subject to limitations due to letter, legend, or control) Schedule 3 Notes Receivable – Payment Present Collectable Original Collateral Rate Due From Maturity Terms Balance Yes/No Amount Total to Page 1 Schedule 4 – life Insurance and Annuities (Including employer provided) Face Pledged Net Cash Cash Value P olicy Loan Company Beneficiary Insured Value Amount Yes/No Total to Page 1

3 Schedule – Deferred Compensation and Retirement Plans 5 Net Plan Access Balance/ Type of Company In Name of Plan Loan Beneficiary Date Value Account Value Total to Page 1 (Includes IRA accounts, KEOGH, 401 K, fully vested benefit plans, etc.) Schedule 6 – Notes Payable (Exclude mortgages listed in Schedules 7 & 8) Payment Original Present Current Collateral Due To Rate Maturity Terms Balance Yes/No Amount Total to Page 1 (If you are a co- maker, list the loan in this schedule and state the borrower’s name in the collateral column)

4 Schedule 7 – Rea l Estate Owned (including partnership interest) Related Debt (Mark * by amount if not personally liable) Taxes Year Cost & Annual Market ocation, Size, L Current Annual # resent P Income Improvements Acquired mprovements I Value Rate L ie nholder Maturity Yes/No Payments Balance Homestead Total to Page 1 – 1 Other wholly owned real estate 2 Totals to Page 1 P artial ownership in real estate % Your portion of market value and debt Totals to Page 1 Regarding Schedules 7 and 8, if the amount of debt which can be legally enforced against you exceeds your % of ownership, please detail in Schedule 9 – O il and Gas Interests (including partnership interests) Schedule 8 Location, Descri p t ion, Type of Net (Mark * by amount if not personally liable) ated Debt el R Taxes Present Date of Year Current perating O Interest % , and Source of Annual Present Valuation luation a V Acquired Rate Lienholder Maturity Yes/No Revenue Valuation Payments Balance 1 2 3 4 5 Your portion of market value and debt Totals to Page 1 Regarding Schedules 7 and 8, if the amount of debt which can be legally enforced against you exceeds your % of ownership, please detail in Schedule 9

5 Schedule 9 – Contingent Liabilities Instructions: State total amount by type of liability and provide appropriate detail in the space below 5 Standby Letter of Credit 1 As Guarantor or Endorser 2 On Leases or Contracts 6 Liability in Excess of % in Partially Owned Assets 3 Legal Claims or 7 Tax Liability if Assets Sold at Stated Value Judgements 8 Other 4 Income Tax Claim or Disputed Amount Maturity or Obligation Am t oun Include whether you anticipate Explanation: Name of Party Receiving Benefit Type having to honor this l iability en ym ts a Timing of P Expiration Date Business in which I am a partner, officer, or principal owner, etc. Nature of Business Business Bank Account I understand that the following questions are addressed to me and I have answered them appropriately. Yes No 1. Are any o f the assets held in trust, in an estate, or in any other name or capacity? mar Yes any of the assets (I) owned or claimed by you r spouse before 2. Were riage, or (II) acquired by you r spouse during No marriage by gift or inheritances, or (III) recovered for personal injuries sustained by your spouse during marriage, or (IV) acquired from the proceeds of liquidation of any of the preceding? Yes No 3. Are any of your real estate properties used by you in your business? 4. Do any of your assets secure any debts which have not been reported in the preceding schedules? Yes No Yes No 5. Are you a party to any suit or are there any unsatisfied judgments against you? Yes No 6. Have been through bankruptcy or made an assignment for benefit of creditors? I have explained fully under “Additional Remarks” on this p age any ‘Yes” answers to the foregoing questions. Yes No 7. I have made a will and the executor is ________________________________________ Additional Remarks

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