Personal Financial Statement Template - Cornerstone Bank Page 2
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3Section 4 – Annual Income For Year Ended _____________, ______________
Contigent Liabilities
Annual Income
Individual
Joint
Annual Expenditure
Individual
Joint
Estimated Amounts
Individual
Joint
Salary, bonuses &
commissions
$
$
Mortgage/rental payments
$
$
Do you have any.. Yes No
$
$
Contingent liabilities
(as endorser,
Real-estate taxes &
Co-maker or
Dividends & interest
$
$
assessments
$
$
Guarantor?)…
$
$
(On leases?
Real estate income
$
$
Taxes-federal, state & local
$
$
On contracts?)
$
$
Involvement in
pending legal
$
$
Insurance Payments
$
$
actions?
$
$
Other income
Other contract payments (car
Contested income
(alimony, child
$
$
payments, charge cards, etc.)
$
$
tax liens?
$
$
support, or separate
Any estimated
maintenance income
need not be revealed
capital gains tax
Alimony, child support,
on the unrealized
if you do not wish to
$
$
maintenance
$
$
asset appreciation?
$
$
have it considered as
a basis for repaying
Other special debt
this obligation.)
$
$
Other expenses
$
$
or circumstances?
$
$
Total Income
$
$
Total Expenditures
$
$
If ‘yes’ to any question(s) describe:
Total Contingent Liabilities
$
$
2
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