Personal Financial Statement



*Personal Financial Statement of:

*Social Security Number:

*As of:

*Home Address:

*City:

*State:

*Zip:

Name of Spouse:

Social Security Number:

Name of Trusts:

Trustees:

Assets and Liabilities


Assets - Amount in Dollars

Cash - Checking Accounts:

Certificates of Deposit:

Notes and Contracts Receivables:

Personal Property (Autos, Jewelry, Etc.):

Real Estate (Market Value):

Other Assets (Please Specify):

TOTAL ASSETS

Cash - Savings Accounts:

Securities - Stocks / Bonds / Mutual Funds:

Life Insurance (Cash Surrender Value):

Retirement Funds (IRA's, 401k, Etc.):

Other Assets (Please Specify):

Liabilties - Amount in Dollars

Current Debt (Credit Card Amounts):

Taxes Payable:

Other Liabilities (Please Specify):

TOTAL LIABILITIES:

Notes Payable (Describe Below):

Real Estate Mortgage (Please Describe):

Other Liablities:


TOTAL NET WORTH:

Signature:

Signature Date:

Personal Finance Statement of:

Assets - Details


Notes and Contracts Held

From whom Owing

Balance Owed

Original Amount

Original
Date

Monthly Payment

Maturity
Date

History Purpose

Securities- Stocks / Bonds / Mutual Funds

Name of Security

Number of Shares

Cost ($)

Market Value ($)

Date of Acquisition

Stock in Privately Held Companies

Company Name

Number of Shares

Invested ($)

Estimated Market Value ($)

Real Estate

Description /Location

Market Value ($)

Amount Owing ($)

Original Cost ($)

Purchase Date

Liabilities


Credit Card & Charge Card Debt

Name of Card / Creditor

Amount Due ($)

Notes Payable (Excluding Monthly Bills)

Name of Creditor

Amount Owing ($)

Original Amount ($)

Monthly Payment ($)

Interest Rate

Secured By (Lien)

Mortgage / Real Estate Loans Payable

Name of Creditor

Amount Owing ($)

Original Amount ($)

Monthly Payment ($)

Interest Rate

Secured By (Lien)


Please Enter Security Code:
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