Personal Financial Statement Docvibol

PERSONAL FINANCIAL STATEMENT Print Name:__________________________________________________________________________ Street Address:_______________________________________________________________________ City:______________________________ State:_____________________ zip code:_______________ Home Phone:______________ Bussiness Phone:_________________ Email:_____________________

ASSETS:

LIABILITIES:

Cash on hand & banks: $________________________ Due to Banks (Loans) Certificates of Deposit:$________________________ Name of Bank(s) Money Market Funds:$_________________________ _______________ $___________________ Stocks & Bonds:$_____________________________ _______________ $____________________ Account/Notes Receivable:$_____________________ Vested Portion of Pension or Profit Sharing:$_______________________________

Real Estate Mortgages Home:$____________________________ Condos, Farm, Etc.:$__________________ Cash Value of Life Insurance:$____________________ Real Estate Taxes due:$_________________ Real Estate Owned: Home:$______________________________________ Apartments, Condo’s:$__________________________ Farm, Business:$______________________________ Other Assets (Itemized): __________________:$__________________________ __________________:$__________________________

Bank Loans – Automobile: _____________: $_____________________ _____________: $_____________________ Credit Card Balances: ___________$_______________________ ___________$_______________________

Automobiles:$__________________________________ Other Debts: Furniture’s:$____________________________________ (e.g. Health, Life Insurance, Money Owed to Fixtures, Machineries & Tools:$____________________ Individuals,) Others:$_______________________________________ ____________$_____________________ ____________$_____________________ ____________$_____________________ TOTAL ASSETS (A):$________________________ (B):$______________________________ TOTAL ASSETS (A) LESS TOTAL LIABILITIES (B):= $__________________ (C) NETT WORTH PRESENT ANNUAL INCOME FROM ALL SOURCES: $___________________________________ Signature(s)_________________________________. ________________________________________ Date:______________________________________ Date:____________________________________