Please provide a list of all assets currently owned by the business.

List each item individually along with

its estimated market value. All items listed with an original purchase cost greater than $5,000 must
include manufacturer Year/Make/Model and Serial/ID Number.
Assets can include, but are not limited to:
• Electronic equipment (i.e. computers, printers, fax machines, external hard drives, servers,
laptops, etc.)
• Office furniture (i.e. file cabinets, desks, chairs, etc.)
• Tools and/or appliances used for business purposes only (i.e. construction equipment,
removable restaurant pieces, etc.)
• Vehicles and machinery (i.e. trucks, trailers, tractors, etc.)

** Please use a separate page for each of your business locations. **

BUSINESS NAME: ABC Corporation

ASSET LOCATION: 123 Main Street, San Francisco, CA 94103

Name of
Item Year / Make / Year Original Market
Quantity Serial # / ID # / VIN Lienholder
Description Model Acquired Cost Value*
(if applicable)
Apple
1 Laptop 2016 $3,000 $1,000 N/A N/A
MacBook
X-Ray Fluoro OEC
1 2014 $100,000 $95,000 A123456789 Wells Fargo
Machine 9600
2018 Ford
1 Truck 2018 $36,000 $27,000 AB123CD456EF7890 Capital One
F150

* Market value is the price an asset would fetch in the marketplace

BUSINESS NAME: URQUIDI INN

ASSET LOCATION:107 brentwood blvd BRENTWOOD TN 37027

Year / Name of
Item Year Original Market
Quantity Make / Serial # / ID # / VIN Lienholder
Description Acquired Cost Value*
Model (if applicable)

2 chairs wood 2015 200 300

 2 computer ibm 2017 1500 1600

1 truck howo 2012 3500 4500

1 tool box chia 2018 1500 1600

1 desk wood 2012 300 500

3 television samsung 2019 3600 4200

* Market value is the price an asset would fetch in the marketplace

CERTIFICATION

I certify that all information contained herein is TRUE and CORRECT to the best of the undersigned’s
knowledge. If you knowingly make a false statement or overvalue a security to obtain a guaranteed
loan from the SBA, you can be fined up to $10,000 and/or imprisoned for not more than five years
under 18 USC 1001; if submitted to a Federally insured institution, under 18 USC 1014 by
Imprisonment of not more than twenty years and/or a fine of not more than $1,000,000. I authorize
the SBA’s Office of Inspector General to request criminal record information about me from criminal
justice agencies for the purpose of determining my eligibility for programs authorized by the Small
Business Act, as amended.

Guadalupe Urquidi owner Guadalupe Urquidi

Print Name & Title Signature