Application For Motor Carrier Certificate Before The Alabama Public Service Commission Page 5

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APPENDIX “C”
FINANCIAL STATEMENT
A financial statement (balance sheet and income/expense statement) for the most recent tax year may be used in lieu of this document.
NET WORTH
ASSETS:
Cash on Hand
Checking Account Balance
Money in Savings Accounts
Market Value of Home(s)
Market Value of Businesses
Furniture, Equipment, etc
Resale Value of Automobiles
Money owed to you
Certificates of Deposit (CDs)
Stocks/Bonds/Mutual Funds
Other:
TOTAL ASSETS:
$
LIABILITIES:
Mortgage and/or Real Estate Loan
Utilities
Maintenance Bills
Payroll
Automobile Loan(s)
Installment Contracts
Credit Card Debts
Loans
Judgments
Cash Advances
Taxes Owed
Medical Bills
Other:
$
TOTAL LIABILITIES:
To find net worth:
TOTAL ASSETS
(Subtract) TOTAL LIABILITES
THIS IS YOUR NET WORTH
$
Revised 2012
APSC Form No. 14H
-5-

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