Form Cc-008 - Certificate Of Competency Application Page 17
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26CERTIFICATE OF COMPETENCY APPLICATION
Form A
Section 6.4 - Business Financial Form
Please fill out in its entirety, accompanied by supporting documentation such as a current bank statement/letter.
(letter only acceptable for a newly formed company)
Company Name: company’s full legal name INC/CORP/LLC (include d/b/a, if applicable)
Current Assets
Cash
$
Notes Receivable
$
Accounts Receivable
$
Stocks
$
Inventories
$
Other Current Assets
$
$
Total Current Assets
Fixed Assets
Office Equipment
$
Cars, Trucks, & Equipment
$
Real Estate
$
Total Fixed Assets
$
$
Total Fixed Assets + Current Assets
Current Liabilities
Notes Payable (within 1 year)
$
Accounts Payable
$
Accrued Taxes
$
Other Current Liabilities
$
Total Current Liabilities
$
Long Term Liabilities
Notes Payable (due in more than 1 year)
$
Mortgage Payable
$
Other Liabilities
$
Total Long Term Liabilities
$
Total Long Term + Current Liabilities
$
Net Worth (Total Assets (-) Total Liabilities)
Total Assets:
$
(-)
Total Liabilities:
$
(=)
Company Net Worth
$
I certify that the information provided on the Financial Statement Form is true and correct.
Printed Name:
Date:
Qualifiers Signature:
Form CC-08-07
Business Financial Form
Rev. 12/9/16
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