Business Financial Statement/balance Sheet - Washington Business Licensing Service

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State of Washington
UBI number
Business Licensing Service
po Box 9034
olympia, Wa 98507-9034
1-800-451-7985
Collection Agency
Business Financial Statement/Balance Sheet
(This form must be completed and submitted with a Business License Application)
a business balance sheet must be completed and submitted by the sole proprietor or the business entity (partnership, corporation,
or limited liability company). The information is required to properly evaluate the applicant’s ability to qualify for a license. The
Department is authorized to make all inquiries considered necessary to verify the accuracy of the statements made in this application
to determine if the applicant qualifies to obtain a license.
Applicant information
A
applicant name (Entity name)
applicant address Street or route, city, state, zip code
Type of business (check one):
Sole proprietor
partnership
LLC
Corporation
State of financial condition as of _______________________ , 20 _______ (must be no more than 3 months old)
B
Assets, liabilities, equity (continued on page 2)
Assets
Current assets
* The total of the four
Cash on hand *
$
starred items must be at
Business checking account *
$
least $7,500; the total
Trust (client funds)
$
of the three bolded items
Savings *
$
must be at least $5,000
Certificates of deposit *
$
accounts receivable (clients)
$
accounts receivable (other)
$
Notes receivable
$
other - specify prepaid expenses
$
$
Total current assets
fixed assets
auto
$
furniture, fixtures, etc.
$
Real estate
$
other - specify: ___________________________
$
$
Total fixed assets
Total assets
$
Liabilities
accounts payable (clients)
$
accounts payable (other)
$
Unpaid state and federal taxes
$
other unpaid taxes - interest
$
Real estate mortgages - payable to:________________
$
Notes payable to banks - unsecured
$
Notes payable to banks - secured
$
Notes payable to other - specify: ________________________
$
other debts (lease agreements, etc., itemize on
separate sheet)
$
Total liabilities
$
for assistance or to request this document in an alternate format, visit or call 1-800-451-7985. Teletype (TTY) users may call 360-705-6718.
BLS-700-331 (05/13/13) page 1 of 2

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