Financial Statement For Businesses
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4FINANCIAL STATEMENT FOR BUSINESSES
Employment Development Department
NOTE: Complete all blocks except “Dept. Use Only” blocks. Write “N/A” (not applicable) in those blocks that do not apply.
Employer Account Number:
Business Phone: (
)
Federal Employer Identification Number:
Name and Address of Business
Sole Proprietor
Other
Partnership
Corporation – State of Inc.:
Date of Inc.:
CA Corp. ID No.
Name, title, and phone number of person completing Financial Statement
Type of Business
List Owner, Partners, Officers, Major Shareholder, etc.
Effective
Phone
Social Security
Driver
Name and Title
Home Address
Date
Number
Number
License No.
Current Assets
$
Cash on Hand
Bank Accounts: Include Savings and Loans, Credit Unions, Line of Credit, etc.
Name of Institution
Address
Type of Account
Account Number
Balance
$
Accounts/Notes Receivable
Name
Address
Amount
$
Securities: Stocks, Bonds, Mutual Funds, Money Market Funds, Government Securities, etc.
Kind
Quantity or Denomination
Where Located
Value
$
Dept. Use Only
Section A
DE 926C Rev. 13 (5-15) (INTERNET)
CU
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Parent category: Legal