Personal Financial Statement Worksheet Template
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4PERSONAL FINANCIAL STATEMENT WORKSHEET
APPLICANT
FULL
EMPLOYMENT/
NAME
NAME OF BUSINESS
)
(IF SELF EMPLOYED
RESIDENCE
POSITION
ADDRESS
BUSINESS
CITY STATE
ADDRESS
& ZIP
BUSINESS PHONE
NUMBER OF
PHONE
DEPENDENTS
D.O.B
SSN
DRIVER’S LICENSES NO.
CO-APPLICANT OR SPOUSE
FULL
EMPLOYMENT/
NAME
NAME OF BUSINESS
(IF SELF EMPLOYED)
RESIDENCE
POSITION
ADDRESS
BUSINESS
CITY STATE
ADDRESS
& ZIP
BUSINESS PHONE
PHONE
______________________________________
D.O.B
SSN
DRIVER’S LICENSES NO.
______________
ASSETS
LIABILITIES & NET WORTH
Current Value
Balance Owing
1. Cash (on hand & in banks)
13. Notes Payable, Banks, Unsecured
$
0
$
(see schedule 1)
(see schedule 7)
2. US Government & Agency Securities
14. Notes Payable, Banks, Secured
(see schedule 2)
$
(see schedule 7)
$
3. Marketable Securities
15. Notes Payable. Others
(see schedule 2)
$
(see schedule 7)
$
4. Non-Marketable Securities
16. Loans Against Life Insurance
(see schedule 3)
(see schedule 4)
$
17. Accounts & Bills Payable
5. Notes Receivable--Itemize
$
(see schedule 7)
$
6. Cash Value--Life Insurance
18. Real Estate Mortgages Payable
(do not deduct loan) (see schedule 4)
$
(see schedule 5)
$
7. Real-estate in Own Name
(see schedule 4)
$
19. Income Taxes Due
$
8. Partial Interests in Real Estate--Net
Equity Values (see schedule 6)
$
20. State Taxes Due
$
9. Automobiles
Year
Make
$
21. Alimony/Child Support
$
10. Furniture and Personal Property
$
22. Other Liabilities--itemize
11. Other Assets--Itemize
$
Mortgage on partial interest in real
$
$
estate (sch. 6)
23. TOTAL LIABILITIES
$
22. Net Worth
$
$
(Total Assets Less Total Liabilities)
$
$
12. TOTAL ASSETS
23. Total Liabilities & Net Worth
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