Personal Financial Statement Page 3
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6SECTION 4 - STATEMENT OF FINANCIAL CONDITION (CONT'D)
LIABILITIES
Monthly Payment
Balance In Dollars
Resl Estate Loans - Primary Residence -
See Schedule E
$0
$0
Resl Estate Loans - Investment Property -
See Schedule E
$0
$0
Resl Estate Loans - Partial Ownership -
See Schedule E
$0
$0
Due to Brokers
$0
$0
Accrued/Estimated Income Tax
$0
$0
Installment Loans - Other -
See Schedule G
$0
$0
Accounts Payable/Credit Cards -
See Schedule H
$0
$0
Other Liabilities -
See Schedule I
$0
$0
Business Loans (If Not Listed Elsewhere)
$0
$0
Other Liabilities - Attached separate itemized sheet
$0
$0
TOTAL LIABILITIES
$0
$0
NET WORTH
$0
TOTAL LIABILITIES AND NET WORTH
$0
SOURCES OF INCOME FOR YEAR ENDING December 31,
2016
Salary, bonuses & commissions
$0
Dividends
$0
Real estate income - annualized from Schedule C and Schedule E
$0
Other income:
$0
(Alimony, child support, or separate maintenance income need not be revealed if you do
not wish to have it considered as a basis for repaying this obligation)
TOTAL INCOME
$0
CONTINGENT LIABILITIES
No
Do you have any contingent liabilities?
If so, describe:
As endorser, co-maker or guarantor?
Amount of contested income tax liens?
PERSONAL INFORMATION
No
Do you have a trust?
If so, is your trust:
N/A
If so, what is the name of your trust?
If so, who are the trustees of your trust?
Do you have a will?
No
If so, name of executor:
Do you currently have an accountant?
No
If so, name of accountant/firm:
Do you currently have an attorney?
No
If so, name of attorney/firm:
No
Are you a partner or officer in any other venture?
If so, describe:
No
Are you obligated to pay alimony, child support, or separate maintenance payments?
If so, describe:
No
Are any assets pledged other than as described on schedules?
If so, describe:
2015
Income tax filed and paid through tax year:
No
Have you been audited by the IRS?
If yes, IRS audited tax years:
Personal bank accounts carried at:
No
Have you ever been declared bankrupt in the last 14 years?
If so, where?
Year
No
Are you a defendant in any suit or legal action?
If so, describe:
No
Have you had a foreclosure in the last 7 years?
If so, describe:
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