Financial Statement

ADVERTISEMENT

FINANCIAL STATEMENT
To be completed to establish need for assistance from the Iowa P.E.O. Project Fund, Inc.
Attach to the Application Form (set all printer margins to 0.5 inches)
NAME (Please Print) _____________________________________________________________________________
(Last)
(First)
(Middle)
Family Assets
a) Deposits in Bank and/or Cash on Hand
b) Stocks, bonds, Certificates of Deposit (attach details)
c) Estimated value of home
Less: Mortgage loan balance
Net equity in home
d) Net value in other real estate owned
e) Vehicle(s) -- Estimated value
Less: Loan on vehicle(s)
Net equity in vehicle(s)
f) Other assets (attach description)
TOTAL ASSETS
Family Liabilities
g) Credit Card(s) – total current balance owed
h) Other loans/obligations (attach description)
TOTAL LIABILITIES
Family Monthly Income (estimated)
Family Monthly Expenses (estimated)
a) Salary (take-home pay)
a) Housing:
-- Rent
-- Mortgage
b) Social Security (net)
b) Property Taxes (paid directly)
c) Utilities/phone
c) Income from investments:
d) Food/groceries
Interest
e) Clothing
Dividends
f) Vehicle expense:
-- Loan payment(s)
d) ADC/FIP
-- Gas/Maintenance
g) Insurance
e) Food stamps
-- Homeowner/Renter
-- Auto
f) Child support/Alimony
-- Medical (cash paid)
h) Medical expense/Doctors
g) Aid from family/others
i) Medications (cash paid)
h) Other income:
j) Child care
(List source and amount)
k) Church/donations
l) Tuition, books, etc.
m) Credit Card(s) minimum
n) Other expenses (attach list)
TOTAL INCOME
TOTAL EXPENSES
MONTHLY NET (INCOME Less EXPENSES)
Date________________________________ Applicant Signature______________________________________________________
Return form and attachments to: Deb Gaskill, 102 N Oak St., Lake Mills, IA 50450-1326
06/14

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go