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INSTRUCTIONS FOR COMPLETING THE PERSONAL FINANCIAL STATEMENT

The first page of the statement requires information related to assets and liabilities. The instructions below will

assist you in completing page one. If an applicant is married, please note the information for married applicants at

the end of these instructions. Please also note that all information on this form relates to the applicant’s personal

financial information. Information about the firm’s assets and liabilities should not be included anywhere on this

statement.

ASSETS

Cash on hand & banks: Enter the amount of cash on‐hand in your personal checking accounts.

Savings Account: Enter the total cash in all personal savings accounts.

Money Market Accounts, Certificates of Deposit (CDs): Enter the value of your personal money market accounts

and certificates of deposit

IRA or other Retirement Accounts: Enter the total value of all IRAs and other retirement accounts, including any

Deferred Compensation and Pension Plans. You may be requested by WVDOT to provide copies of the most recent

statements to substantiate the amount listed.

Accounts & Notes Payable: Enter the total value of all monies owed to you personally, if any. This should include

shareholder loans to the applicant firm.

Life Insurance: Enter the cash surrender value of any life insurance policies. A complete description is required in

Section 8, on the second page of the Statement.

Stocks and Bonds: Enter the current market value of your stocks/bonds. A complete listing and description is

required in Section 3, on the second page of the Statement.

Real Estate: Enter the current fair market value of all real estate owned by you personally (not by your firm).

A complete listing and description of all real estate owned is required in Section 4.2 on the second page of the

statement. Note that you may have two entries for real estate: (1) your primary residence and (2) other real

estate you own personally.

Automobile: Enter the current fair market value of all automobiles that you personally own.

Other Personal Property: Enter the current fair market value of all other personal property owned by you, but not

included in the previous sections (for example, furniture, jewelry, etc.). A complete description of these assets is

required in Section 5.

Other Assets: Enter the current fair market value of all other assets you own personally that are not included in the

previous sections. A complete description of these assets is required in Section 5.

LIABILITIES

Accounts Payable: Enter the total value of all unpaid accounts payable that is your responsibility (for example, gas,

electric, telephone bills, etc.). This does not include bills in the firm’s name. A complete description of these

accounts will be required in section 7 on page 2.

Notes Payable to Banks and Others: Enter the total amount due on all Notes Payable to Banks and others, paid on

an installment basis. Please be sure to indicate the total monthly payment in the space provided. This should

include the amount of any loans from the applicant firm. This should not, however, include any mortgage balances.

Form Sba Form 413 - Personal Financial Statement/adjusted Personal Net Worth Worksheet Page 6