Personal Financial Statement Page 2
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5DATE OF STATEMENT____________, 20_____
*Please attach a separate sheet if you need
more space to complete a detail schedule.
ASSETS
AMOUNT
LIABILITIES
AMOUNT
Cash in Heritage Bank of Commerce
Notes Payable to Heritage Bank of Commerce
Cash in Other Banks (Detail)
Accounts Payable
Accounts Receivable
Notes Payable to Others (Schedule 7)
Notes Receivable (Schedule 1)
Income Taxes Payable
Mortgages & Deeds of Trust Owned (Schedule 2)
Other Taxes Payable
Securities Owned (Schedule 3)
Cash Surrender Value of Life Insurance (Schedule 4)
Loans on Life Insurance (Schedule 4)
Real Estate (Schedule 5)
Mortgages or Liens on Real Estate (Schedule 6)
Automobiles
Installment Contracts Payable
Credit and Charge Cards
Personal Property
IRA Account
Other Liabilities (Detail)
Other Assets (Detail)
TOTAL LIABILITIES
NET WORTH
TOTAL
TOTAL
ANNUAL INCOME
ANNUAL EXPENDITURES
CONTINGENT LIABILITIES
Employment Income
Property Taxes
As Endorser
Income Taxes
As Guarantor
Dividends
Mortgage P & I
On Damage Claims
Interest
Contract Payments
For Taxes
Rentals (Schedule 5)
Insurance
Other (Detail)
Alimony Child support
Living Expense
Other
Alimony, Child support
Other
Total
=
Total
Total
Income
Expenditures
Contingent
Liabilities
SCHEDULE 1 NOTES RECEIVABLE
NAME OF DEBTOR
COLLATERAL
PAYABLE
MAURITY
TOTAL
DATE
AMOUNT DUE
$
per
$
per
$
per
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