Personal Financial Statement Balance Sheet
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TOTAL ASSETS REMINDER - IF NOT COMPLETED JOINTLY, LIST ONLY YOUR INTEREST IN ANY JOINTLY HELD ASSETS LIABILITIES SCHEDULE A - CASH BALANCES 1 of 3 Name Location of Institution Acct Type Acct Pledged (Yes/No) Ownership Balance TOTAL CASH BALANCES - LINE 1 SCHEDULE B - MARKETABLE SECURITIES of Shares Name/Description of Securities Pledged (Yes/No) Registered Owner(s) Market Value TOTAL MARKET VALUE - LINE 2 SCHEDULE C - REAL ESTATE OWNED, list on additional sheet if necessary Date Acquired Owned Mortgaged (Yes/No) Location Type Cost Net Rental Income Market Value TOTAL MARKET VALUE - LINE 3 SCHEDULE D - BUSINESS INVESTMENTS Cash Distributions Name Business Type Date Acquired Owned Cost Current Year Prior Year Net Equity TOTAL NET EQUITY - LINE 4 SCHEDULE E - LOANS PAYABLE Lender Original Amount Interest Rate Maturity Date Collateral Description Monthly Payment Current Balance TOTAL LOAN BALANCES - LINE 8 SCHEDULE F -MORTGAGES PAYABLE Lender Original Amount Interest Rate Maturity Date Collateral Description Monthly Payment Current Balance 2 of 3 TOTAL LOAN BALANCES - LINE 9 SCHEDULE G - OTHER LIABILITIES Owed To Original Amount Interest Rate Maturity Date Monthly Payment Collateral Description Current Balance TOTAL OTHER LIABILITIES - LINE 10 INCOME EXPENSES INCOME Applicant Co-Applicant Applicant EXPENSES Co-Applicant Salary Personal Living Expenses Rental/Business Income Loans Payable Other Income Other Expenses TOTAL INCOME TOTAL EXPENSES Describe Source of Other Income Above Describe Other Expenses Above Applicant Have any judgments been entered against you Co-Applicant Yes No Yes No Yes No Yes No If yes, please describe: Have you ever filed bankruptcy If yes, when and where: Tax Preparer: Phone: The information contained in this statement is provided for the purpose of obtaining or maintain credit with you on my/our behalf or on the behalf of persons, firms or corporations in whose behalf I/we may, either individually or jointly with other, ex
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