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/