1. Personal Financial Statement
Name:
As of:
Assets Amount in Dollars Liabilities Amount in Dollars
Cash - checking accounts Current Debt (Credit cards,
Cash - savings accounts Accounts)
Certificates of deposit Notes payable (describe below)
Securities - stocks / bonds / mutual Taxes payable
funds
Notes & contracts receivable Real estate mortgages (describe)
Life insurance (cash surrender Other liabilities (specify)
value) Other liabilities (specify)
Personal property (autos, jewelry, Total Liabilities
etc.)
Retirement Funds (eg. IRAs, 401k)
Real estate (market value)
Other assets (specify)
Other assets (specify)
Total Assets Net Worth
Signature: Date:

2. Personal Finance Statement of:
Details
1. ASSETS - Details
Notes and Contracts held
Monthly
From Whom Owing Balance Owing Original Amount Original Date Payment Maturity Date History / Purpose
$ $ $
Securities: stocks / bonds / mutual funds
Date of
Name of Security Number of Shares Cost Market Value Acquisition
$ $
Stock in Privately Held Companies
Est. Market
Company Name No. of shares $ Invested Value
$ $
Real Estate
Description / Location Market Value Amount Owing Original Cost Purchase Date
$ $ $

3. 2. LIABILITIES - Details
Credit Card & Charge Card Debt
Name of Card / Creditor Amount Due
$ -
Notes Payable (excluding monthly bills)
Monthly Secured by
Name of Creditor Amount Owing Original Amount Payment Interest Rate (Leine)
$ - $ - $ -
Mortgage / Real Estate Loans Payable
Monthly Secured by
Name of Creditor Amount Owing Original Amount Payment Interest Rate (Leine)
$ - $ - $ -