To: From: Jeffrey Epstein Sent: Sun 1/17/2010 11:59:52 PM Subject: Re: A B C l) E F (S I Financial Statement ) 3 Applicant: Offer Amount: 4 Co-Applicant: Property: 5 6 The following is being submitted as an accurate sta omen of the financial condition of the undersigned o the day of . 2007. 7 8 ASSETS LIABILITIES 9 Applicant Co -Applicant Applicant Co-Applicant It) Cash in banks $0 SO Notes Payable: SO SO I I Money Markets Funds SO SO To Banks SO SO 12 Contract Deposit $0 SO To Rotative SO SO 13 Investments: Bonds & Stocks $0 $0 To Others SO SO 14 Investment in Own Business $0 $0 Installment Accounts Payable SO SO 15 Real Estate Owned (see schedule) 50 SO Automobile SO $0 16 Automobiles (1994 Isuzu) 50 SO Other SO $0 (7 Personal Property & Furniture SO $0 Other Accounts Payable SO SO Is Life Insurance $0 SO Mortgages Payable on Real Estate SO $0 I 9 Retirement Funds/IRA SC SO Unpaid Real Estate Taxes SO SO 20 401K $0 $0 Unpaid Income Taxes SO SO 2I KEOGH SO $0 Outstanding Credit Card Loans SO SO 22 Profit Sharing/Pension Plan SO Other Debts SO $0 23 Other Assets TOTAL LIABILITIES 24 TOTAL ASSETS SC NET WORTH SO SO 25 COMBINED ASSETS SO COMBINED SO 26 27 SOURCE OF INCOME CONTINGENT LIABILITIES 28 Applicant Co-Applicant 29 Base Salary 50 50 N/A 30 Overtime Wages SO $0 Alimony Payments (Annual) NA 31 Bonus & Commissions SO SO Child Support NIA 32 Dividends & Interest Income $0 $0 Are you a defendant in any legs: action no 33 Real Estate Income 50 SO Are there any unsatisfied judgments? no EFTA_R1_00195209 EFTA01821878