Financial Statement Form


PERSONAL FINANCIAL STATEMENT

Statement of Assets & Liabilities For:___________________________ Social Security No. ___________________________

As of this: ____________________________ 

Day of: _______________, 20 ____.

CURRENT ASSETS                                                          CURRENT LIABILITIES

Cash on Hand                                    $: Notes Payable, Bank : $:

Cash in Banks                                                                    Notes Payable, Bank :                                     $:

$: Notes Payable, Other

$: $:

$: $:

Accounts Receivable                                                         Account Payable                                                 $:

$: Accruals                                                                $:

Stocks, Bonds & Other Securities                                    Taxes                                                                     $:

Total (Schedule A)                             $: Other Current Liabilities

Notes Receivable                                $: $:

Cash Value Life Ins                           $: $:

Other Current Assets                                                                                                                                          $:

$: $:

TOTAL CURRENT ASSETS $: TOTAL CURRENT LIABILITIES $:

FIXED ASSETS DIFFERED LIABILITIES

Real Estate (Schedule B)                                                  Mortgages (Schedule D)

Homestead                                          $: Homestead, Bank :                                         $:

Investment                                          $: Investment, Bank :                                         $:

Business                                               $: Business :                                                       $:

Other                                                     $: Other :                                                            $:

Prepaid Expenses                               $: Other Debts Maturing 1 Year or More

Other Fixed Assets/investments                                       (Schedule E)                                                         $:

Total (Schedule C)                             $: $:

$: $:

$: Borrowed From Life Insurance                        $:

Personal Property/Equipment                                          TOTAL DEFERRED LIABILITIES $:

$:

$: TOTAL OF ALL LIABILITIES $:

$:

$: NET WORTH $:

TOTAL FIXED ASSETS $: TOTAL NET WORTH $:

TOTAL OF ALL ASSETS $: TOTAL LIABILITY & NET WORTH $:

The undersigned hereby certifies that each statement herein contained is true, and this statement is made for the purpose of inducing COMPANY to become surety for the undersigned or to accept the undersigned as Indemnitor. Authority is granted to any firm, individual, or corporation, and any financial institution to furnish information concerning the statements herein or pertaining to the Undersigned’s financial standing, credit or manner of meeting obligations.

Signed by: _________________________________ Date:

SCHEDULE “A” STOCKS, BONDS & SECURITIES

Description of Stock or Bond Par Value Market Value Pledged to Secure
       
       

SCHEDULE “B” REAL ESTATE

Description Location Market Value MortgageAmount MonthlyPayments MonthlyIncome
         
         
         

SCHEDULE “C” INVESTMENTS

Description of Investment Market Value Encumbrance /Mortgage Annual Income 
       
       
       

SCHEDULE “D” MORTGAGES

Mortgagee/Bank & Address Outstanding Balance Monthly Payment
     
     
     

SCHEDULE “E” OTHER DEBTS

Mortgagee/Bank & Address OutstandingBalance Monthly Payment
     
     
     

State Specific Real Estate Forms

–For State Specific Real Estate Forms you can download in Word format, go to http://www.uslegalforms.com/realestate/