Form Sba Form 413 - Personal Financial Statement/adjusted Personal Net Worth Worksheet Page 2
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9OMB APPROVAL NO. 3245-0188
EXPIRATION DATE: 09/30/2014
PERSONAL FINANCIAL STATEMENT
As of
,
U.S. SMALL BUSINESS ADMINISTRATION
Complete this form for: (I) each proprietor; (2) general partner; (3) managing member of a limited liability company (LLC); (4) each owner of 20% or more of
the equity of the Applicant (including the assets of the owner's spouse and any minor children); and (5) any person providing a guaranty on the loan. Return
completed form to: 7(a) loans - to the lender processing the SBA application; 504 loans - to the Certified Development Company processing the SBA
application; Disaster loans - to the Disaster Processing and Disbursement Center at 14925 Kingsport Road, Fort Worth, TX 76155-2243; and 8(a)/BD
applicants who are individuals claiming social and economic disadvantaged status and their spouses - electronically at or send hard
copy with paper application to either of the two following offices:
8(a) BD
Mail to the following address, if your firm is
Mail to the following address, if your firm is
only
located in one of the states below:
located in one of the states below:
US Small Business Administration
DPCE Central Office Duty Station
Small Business Administration
Parkview Towers
Division of Program Certification and Eligibility
1150 First Avenue
455 Market Street, 6th Floor
10th Floor, Suite 100I
San Francisco, CA 94105
King of Prussia, PA 19406
MA, ME, NH, CT, VT, RI, NY, PR (Puerto Rico), VI (US Virgin
Islands), NJ, PA, MD, VA, WV, DC, DE, GA, AL,NC, SC, MS,
IL, OH, MI, IN, MN, WI, TX, NM, AR, LA, OK, MO, IA
FL, KY, TN
Name
Business Phone
Residence Address
Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
ASSETS
LIABILITIES
(Omit Cents)
(Omit Cents)
$
Cash on hand & in Banks
$
Accounts Payable
$
Savings Accounts
$
Notes Payable to Banks and Others
IRA or Other Retirement Account
$
(Describe in Section 2)
(Describe in Section 5)
Installment Account (Auto)
$
Accounts & Notes Receivable
$
Mo. Payments
$
(Describe in Section 5)
Installment Account (Other)
$
Life Insurance-Cash Surrender Value Only
$
Mo. Payments
$
(Complete Section 8)
$
Loan on Life Insurance
$
Stocks and Bonds
$
Mortgages on Real Estate
(Describe in Section 3)
$
(Describe in Section 4)
Real Estate
(Describe in Section 4)
$
Unpaid Taxes
Automobiles - Total Present Value
(Describe in Section 6)
$
(Describe in Section 5, and include
$
Other Liabilities
Year/Make/Model)
(Describe in Section 7)
$
Other Personal Property
0
$
Total Liabilities
(Describe in Section 5)
0
$
Other Assets
$
Net Worth
(Describe in Section 5)
0
0
$
$
Total
Total
Section 1.
Source of Income
Contingent Liabilities
$
$
Salary
As Endorser or Co-Maker
Net Investment Income
$
Legal Claims & Judgments
$
$
$
Real Estate Income
Provision for Federal Income Tax
Other Income (Describe below)*
$
Other Special Debt
$
Description of Other Income in Section 1.
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
SBA Form 413 (08-11) Previous Editions Obsolete
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