Statement Date:
Name: SSN:
Address: Birthdate:
City, State Zip: Dependents:
Home Telephone: Business Telephone:
1 21
2 22
3 23
4 24
5 25
6 26
7 27
8 28
9 29
10 $0.00 30
11 31
12 32
13 33 $0.00
14 34
15 35
16 36
17 37
18 38 $0.00
19 39 Net Worth (Total Assets - Total Liabilities) $0.00
20 $0.00 40 $0.00
$0.00 $0.00
Are any Assets Pledged? As Endorser, Co-maker or Guarantor- Yes
Are you a Defendant in any Suits or Legal Actions? On Leases or Contracts
Have you ever been declared Bankrupt in the last 10 years? Federal - State Income Taxes
A CASH IN BANKS AND NOTES DUE TO BANKS
Type of Account Type of Ownership Notes Due Banks
COLLATERAL (If any)
& Type of Ownership
PERSONAL FINANCIAL STATEMENT
Other Income of Other Person - Itemize
Rental & Lease Income (Net)
Other Persons Salary, Bonuses & Commissions
TOTAL LIABILITIES & NET WORTH
Salary, Bonuses & Commissions
TOTAL CURRENT LIABILITIES
Real Estate Mortgage Payable
Liens & Assessments Payable
Other Liabilities Due within 1 Year - Itemize
Notes Due to Relatives & Friends
Unpaid Income Taxes Due - Federal State
Other Unpaid Taxes & Interest
Loans on Life Insurance Policies
Contract Accounts Payable
Other Securities - Not Readily Marketable
Cash Value of Life Insurance
Other Marketable Securities
Notes & Accounts Receivable - Good
Other Assets Readily Convertible to Cash - Itemize
ESTIMATE OF ANNUAL EXPENSES
Mortgages & Contracts Owned
Notes & Accounts Receivable - Doubtful
Notes Due from Relatives & Friends
PERSONAL FINANCIAL STATEMENT 1
Resume Templates 1210 Document(s)
