FORM 4.

General Form used by the Guaranty Trust Company of New York City.

TOTAL.

Capital Stock: Preferred. $. Common.$

Surplus and Undivided Profits.

TOTAL.

.Has Real Estate been independently appraised?.
Is above Statement based upon audit of outside accountant?.
Have any changes of importance occurred in the company's condition since inventory above mentioned?
.Is Merchandise Inventory valued at Cost or Present Market Prices?.

How is Mortgage or Bond Issue Secured?.

Any Notes or Accounts You Owe Secured in any way, if so, how?
Notes Receivable Discounted at Bank not included in above Statement, $.
Amount of Accounts Payable Past Due, $
Amount of Notes Payable Past Due, $.
Are any of the Accounts or Notes Receivable shown above Pledged or Assigned? If so, give particulars.

Are any of the Assets shown above Pledged or Assigned in any way not previously indicated? If so, give particulrrs.

Contingent Liability as Endorser or otherwise (aside from Discounted Notes Receivable) $.

How much Depreciation has been allowed on Machinery and Fixtures during Fiscal Year, closing as above? $
Amount of Fire Insurance carried on Merchandise

Amount Credit Insurance carried, $.

Amount of Dividends paid during year ending as above, $.

Bank with.

Trade References:

On Buildings, etc. $..

Amount Casualty Insurance carried $.