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INSTRUCTIONS FOR COMPLETING THE PERSONAL FINANCIAL STATEMENT

Provisions for Federal Income Tax: Enter the total amount of all Federal taxes for which you are potentially liable

due to an anticipated gain on the pending sale of an asset or other circumstances, such as pending disputes or

litigation which could possibly result in a personal tax liability.

Other Special Debt: Enter the total amount due on all remaining potential debts not accounted for, in your name

individually or your share of a joint debt.

The second page of the statement requires specific information about many of the items entered on page one. This

means that the detailed information included in sections of page two may be combined, within that section, and

entered as a total on page one. You may find it easiest to complete page two first. Please 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.

SECTION 2 – NOTES PAYABLE TO BANKS AND OTHERS Enter the name and address of note holder(s), original

balance, current balance, payment amount, frequency, and how secured for each note payable by you personally;

this number will also be entered in the “Liabilities” column on page one.

SECTION 3 ‐‐ STOCKS AND BONDS Enter the number of shares, names of securities, cost, fair market value, and the

date of fair market value for all shares of stocks and bonds held.

SECTION 4 ‐‐ REAL ESTATE OWNED – Do NOT include your primary residence Enter the type of property, address,

date of purchase, original cost, present fair market value, name and address of mortgage holder, mortgage

account number, mortgage balance, amount of payment, and status of mortgage for all real estate held. Second

mortgages also should be included in this section. Please ensure that this section contains all real estate owned

other than your primary residence, including rental properties, commercial properties, etc. The fair market values

in this section should correspond with the combined “Real Estate” amounts listed in the “ASSETS” column on page

one. Additionally, the mortgage balance values in this section should correspond with the combined “Mortgages on

Real Estate” amount listed in the “LIABILITIES” column on page one.

SECTION 5 ‐‐ OTHER PERSONAL PROPERTY Describe the “Other Personal Property” and “Other Assets” owned as

listed in the “ASSETS” column. This entry should match the combined total for “other personal property” and

“other assets” in the “ASSETS” column on page one of this Statement.

SECTION 6 ‐‐ UNPAID TAXES Describe in detail, as to the type, to whom payable, when due, amount, and to what

property, if any, the tax lien attaches. This amount should match the unpaid taxes listed in the “LIABILITIES”

column on page one. If none, state NONE. This section should not include the contingent tax liabilities or

anticipated taxes owed for the current year.

SECTION 7 ‐‐ OTHER LIABILITIES Describe in detail any other personal financial liabilities, or your personal share of

any joint liabilities; this should match the value listed in the “LIABILITIES” column on page one. If none, state

NONE.

SECTION 8 ‐‐ LIFE INSURANCES HELD Describe all life insurance policies held. Please be sure to include the face

amount of the policies, name of insurance company, beneficiaries and cash surrender values of the policies, as well

as any loans against each policy.

If an individual is married, please note the following:

*All assets and liabilities, except the ownership interest in the firm, should be halved accordingly on the form if

jointly held.

*If assets and liabilities are separately owned, these items should only be reported on the respective owner’s form.

Form Sba Form 413 - Personal Financial Statement/adjusted Personal Net Worth Worksheet Page 8