Sba Form 413 - Personal Financial Statement
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4OMB APPROVAL NO. 3245-0188
PERSONAL FINANCIAL STATEMENT
As of
,
U.S. SMALL BUSINESS ADMINISTRATION
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder
owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.
Name
Business Phone
Residence Address
Residence Phone
City, State, & Zip Code
Business Name of Applicant
ASSETS
(Omit Cents)
LIABILITIES
(Omit Cents)
Cash on hand & in Banks ................................ $ __________________
Accounts Payable ............................................ $ __________________
Savings Accounts ............................................ $ __________________
Notes Payable to Banks and Others ................ $ __________________
(Describe in Section 2)
IRA or Other Retirement Account .................... $ __________________
Installment Account (Auto) .............................. $ __________________
Accounts & Notes Receivable.......................... $ __________________
Mo. Payments $ _____________
Life Insurance-Cash Surrender Value Only ...... $ __________________
Installment Account (Other) ............................ $ __________________
(Complete Section 8)
Mo. Payments $ _____________
Loan on Life Insurance .................................... $ __________________
Stocks and Bonds ........................................... $ __________________
(Describe in Section 3)
Mortgages on Real Estate ............................... $ __________________
(Describe in Section 4)
Real Estate ...................................................... $ __________________
(Describe in Section 4)
Unpaid Taxes .................................................. $ __________________
(Describe in Section 6)
Automobile-Present Value ............................... $ __________________
Other Liabilities ................................................ $ __________________
Other Personal Property .................................. $ __________________
(Describe in Section 7)
(Describe in Section 5)
Total Liabilities ................................................. $ __________________
Other Assets ................................................... $ __________________
Net Worth ....................................................... $ __________________
(Describe in Section 5)
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.
Section 2. Notes Payable to Banks and Others.
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Original
Current
Payment
Frequency
How Secured or Endorsed
Name and Address of Noteholder(s)
Balance
Balance
Amount
(monthly, etc.)
Type of Collateral
SBA Form 413 (3-05) Previous Editions Obsolete
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Parent category: Business