ASSUMES NO LIABRITY TO THE UNDERSIGNED OR ANY OTHER PERSON ARISING OUT OF OR ROARK TO THIS APPLICATION OR THE SALE CONTEMPLATED HEREBY. APPLICANT'S SIONATL/RE: DATE STCHED CO•APPUCAAO'S SKAIMAIE DATE SICRED- EFTA00729702 FINANCIAL STATEMENT Name: Address: Assets: Total of cash in banks, CMA's,