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* Please Note: Alimony, child support, or maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.
Submission of this form authorizes Plains State Bank to verify information provided herein, including but not limited to employment and credit history.
This application is not for consumer purpose mortgage loans. For loans that use real property or a primary residence to secure a consumer loan, please contact your local Plains State Bank for more information.
Relationship to Applicant