Financial Statement
As of ________________
|
Cash |
$
__________
|
|
Mortgages on Residence |
$
__________
|
|
Stocks, Bonds |
$
__________
|
|
Notes Payable-Automobiles |
$
__________
|
|
Retirement, IRAs |
$
__________
|
|
Other Liabilities |
$
__________
|
|
Net Value of Businesses |
$
__________
|
|
Total Liabilities |
$
__________
|
|
Value of Residence |
$
__________
|
|
Net Worth |
$
__________
|
|
Other Real Estate |
$
__________
|
|
|
|
|
Automobiles |
$
__________
|
|
|
|
|
Other Assets |
$
__________
|
|
|
|
|
Total Assets |
$
__________
|
|
|
|
Have you ever filed for bankruptcy?
______________________________________________
Have you ever been arrested or convicted of a felony?
__________ __________
____________
Signature:
______________________________________________
Date:
__________________________________________________
