Assets
Cash on Hand and in Banks
$
Stocks, Bonds & Mutual Funds (Current Market Value)
Certificates of Deposit
Money Market Funds
Accounts, Loans and Notes Receivable
Cash Value of Life Insurance
Value of Businesses owned
Real Estate Owned (Current Market Value)
Automobiles- Number [ ] (Current Market Value)
Retirement Account Value (IRA, 401K, Etc)
Household Furnishings and Personal Effects
Other Assets (Itemize below)
Total Assets
Liabilities
Credit Card Debt
Other Credit Debt (Stores, Gas Stations, Etc)
Home Mortgage
Home Equity Loans
Other Mortgages
Auto Loans
Other Loans Outstanding (Itemize below)
Personal Guarantees of other’s debts (Itemize below)
Other Liabilities (Itemize below)
Total Liabilities
Net Worth
Total Assets less Total Liabilities Net Worth
Source of Income
Annual Salary or Wages
Dividends and Interest
Bonus and Commissions
Real Estate Income
Other Income (Itemize below)
Annual Income Total
Itemize Details
Other Assets:
Other Liabilities:
Other
Income:
The individuals below certify this information to be a true
and correct record of their finances. Name(s): &
Street Address
City: State: Zip Code:
Date: Phone: Email:
