Business Financial Statement/balance Sheet - Washington Business Licensing Service Page 2
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Assets, liabilties, and equity (continued from page 1)
Corporation (if your company is not a corporation, skip this portion and fill out the non-corporation portion below)
Shareholder’s equity
Common & preferred stock
$
Retained earnings
$
Current earnings
$
Less: Treasury stock
)
($
Total shareholder’s equity
$
Total liabilities and
shareholder’s equity
$
(This amount must be at least
$7,500 and match Total
assets on Page 1)
Non-corporation (complete this portion if your company is a sole proprietorship, LLC, or partnership)
Owner’s equity
Owner’s paid-in capital
$
Retained earnings
$
Current earnings
$
Total owner’s equity
$
Total liabilities and owners equity
$
(This amount must be at least
$7,500 and match Total
assets on Page 1)
C
Additional Information
List all persons with more than a 20% interest in the business.
% of interest
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
1. Does the applicant agency have any debts, obligations, or potential liabilities of the applicant
Yes
No
not listed elsewhere on this application?
2. Is the applicant an endorser, co-maker/signer or guarantor on an outstanding liability?
Yes
No
3. Are there any assets of the applicant, including stock, pledged or assigned other than those
Yes
No
described?
4. Can the applicant agency meet its obligations as they mature?
Yes
No
If you answered yes to questions 1-3, please attach additional pages and explain in detail,
including an estimate of the liability or debt where applicable.
D
Certification
I certify under penalty of perjury that the information contained in this document is true and correct.
Date
Signature (must be company owner, partner, or officer)
Signer’s name and title (please print)
X
Prepared by (please print)
Preparer’s phone number
(
)
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 2 of 2
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