Commercial Debtor Financial Statement Page 3
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2
3
4Section II Assets and Liability Analysis
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Description
Liabilities
Equity
Amount of
Name and Address of
Date
Date of
Mkt.
Cur.
Bal. Due
In
Mo. Pymt.
Lien/Note Holder/Obligee
Pledged
Final Pymt.
Value
Asset
16 Cash on hand
17 Bank Accounts
18 Accounts/Notes receivable
19 Life insurance loan value
20
Real
a
Property
(from
b
item 12)
c
21
Vehicles
a
(model, year,
and license)
b
c
22
Machinery
a
and
equipment
b
(specify)
c
23
Merchandise
a
inventory
(specify)
b
24
Other assets
a
(specify)
b
25 Other
a
Liabilities
(including
b
notes and
judgements)
c
d
e
f
g
h
26 Federal taxes owed (prior years)
27 Total
$
$
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