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Personal Financial Statement - Legal Forms

Personal Financial Statement Form. This is a Legal Forms form and can be used in Credit And Collection .
 Fillable word Last Modified 5/9/2001
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PERSONAL FINANCIAL STATEMENT Date: ______________________ Submitted To: _______________ PERSONAL INFORMATION Applicant's Name _____________________________________________________ Employer _____________________________________________________ Employer's Address _____________________________________________________ Business Phone Number _____________________________________________________ Number of Years with Employer _____________________________________________________ Title/Position _____________________________________________________ Name of Previous Employer & Position (if with current employer less than 3 years) _____________________________________________________ Number of Years with Previous Employer_________________________________ Home Address _____________________________________________________ Home Phone _____________________________________________________ Social Security No. _____________________________________________________ Date of Birth _____________________________________________________ Co-Applicant's Name_____________________________________________ Employer _____________________________________________________ Employer's Address _____________________________________________________ Business Phone Number _____________________________________________________ Number of Years with Employer _____________________________________________________ Title/Position _____________________________________________________ Name of Previous Employer & Position (if with current employer less than 3 years) _____________________________________________________ Number of Years with Previous Employer_________________________________ 2001 © American LegalNet, Inc. Home Address _____________________________________________________ Home Phone _____________________________________________________ Social Security No. _____________________________________________________ Date of Birth _____________________________________________________ CASH INCOME & EXPENDITURES STATEMENT FOR YEAR ENDED ____________ ANNUAL INCOME AMOUNT ($) Salary (applicant) _________________________________ Salary (co-applicant) _______________________________ Bonuses & Commissions (applicant) ___________________ Bonuses & Commissions (co-applicant) _________________ Rental Income ____________________________________ Interest Income ___________________________________ Dividend Income __________________________________ Capital Gains ____________________________________ Partnership Income ________________________________ Other Investment Income ___________________________ Other Income (list) ________________________________ Total Income $___________ Are any significant changes expected in the next 12 months? [ ] Yes [ ] No (If yes, attach information.) ** Income from alimony, child support, or separate maintenance income need not be revealed if the applicant or co-applicant does not wish to have it considered as a basis for repaying this obligation. ANNUAL EXPENDITURES AMOUNT ($) Federal Income and Other Taxes _____________________ 2001 © American LegalNet, Inc. State Income and Other Taxes _______________________ Rental Payments, Co-op, or Condo Maintenance _________________________ Mortgage Payments (Residential) _____________________ (Investment) _____________________ Property Taxes (Residential) _________________________ (Investment) _____________________ Interests & Principal Payments on Loans _______________ Insurance ________________________________________ Investments (Including tax shelters) ___________________ Alimony/Child Support _____________________________ Tuition __________________________________________ Other Living Expenses ______________________________ Medical Expenses _________________________________ Other Expenses (list) _______________________________ Total Expenditures $___________ Balance Sheet as of ____________ ASSETS Cash in this Bank _______________________________ (Including money market accounts, CDs) Cash in Other Financial Institutions (list) _________________________________________ (Including money market accounts, CDs) Readily Marketable Securities (Schedule A)____________ Non-Readily Marketable Securities (Schedule A) ___________________ Accounts and Notes Receivable _______________________________ Net Cash Surrender Value of Life Insurance (Schedule B) __________ Residential Real Estate (Schedule C) ____________________________ Real Estate Investments (Schedule C) ___________________________ 2001 © American LegalNet, Inc. AMOUNT ($) Partnerships / PC Interests (Schedule D) _________________________ IRA, Keogh, Profit-sharing & Other Vested Retirement Accounts ___________________________ Personal Property (including automobiles) _________________________ Other Assets (list): ______________________________ Total $__________ LIABILITIES AMOUNT ($) Notes Payable to this Bank ________________________ Secured _________________________________ Unsecured _______________________________ Notes Payable to Others _______________________ Secured _________________________________ Unsecured _______________________________ Accounts Payable (including credit cards) ____________ Margin Accounts _______________________________ Notes Due: Partnership (Schedule D) _______________ Taxes Payable _________________________________ Mortgage Debt (Schedule C) ______________________ Life Insurance Loans (Schedule B) _________________ Other Liabilities (list): __________________________ Total Liabilities $__________ Net Worth $__________ CONTINGENT LIABILITIES Are you a guarantor, comaker, or endorser for any debt of an individual, corporation, or partnership? [ ] Yes [ ] No $__________ Do you have any outstanding letters of credit or surety bond? [ ] Yes [ ] No $_______ 2001 © American LegalNet, Inc. Are there any suits or legal actions pending against you? Are you contingently liable on any lease or contract? Are any of your tax obligations past due? [ ] Yes [ ] No $__________ [ ] Yes [ ] No $__________ [ ] Yes [ ] No $__________ What would be your total estimated tax liability if you were to sell your major assets? $__________ If yes for any of the above, give details: SCHEDULE A - ALL SECURITIES (including non-money market mutual funds) Readily Marketable Securities (including U.S. Governments and Municipalities)* No. of Shares or Face Value _____________________________________________________ Description _____________________________________________________ Owner(s) ________________________
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