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Personal Financial Statement _Excel_ - WORC

VIEWS: 51 PAGES: 3

									                                                           EOF
                                                Economic Opportunities Fund
                                   a subsidiary of Women's Opportunities Resource Center
                                                     PERSONAL FINANCIAL STATEMENT



                                                                                                                                       Date:
Name                                                                                                                              Business Phone

Residence Address                                                                                                                 Residence Phone

City, State, & Zip Code

Business Name of Application/Borrower

                                  ASSETS                                                                            LIABILITIES
                                                                      (Currently)                                                                         (Currently)

Cash on Hand & In Bank                                            $                 Accounts Payable                                                  $
                                                                                    Notes Payable to Banks and Others
Savings Accounts                                                  $                 (Describe in Section 2)                                           $
                                                                                    Installment Account (Auto) Monthly
IRA or Other Retirement Account                                   $                 Payment(s): $ _________                                           $
                                                                                    Installment Account (Other)
Accounts & Notes Receivable                                       $                 Monthly Payment(s): $ _________                                   $
Life Insurance - Cash Surrender Value Only
(Complete Section 8)                                              $                 Loan on Life Insurance                                            $
                                                                                    Mortgage on Real Estate
Stocks & Bonds (Descrbe in Section 3)                             $                 (Describe in Section 4)                                           $

Real Estate (Describe in Section 4)                               $                 Upaid Taxes (Describe in Section 6)                               $

Automobile - Present Value                                        $                 Other Liabilites (Describe in Section 7)                          $

Other Personal Property (Describe in Section 5)                   $                 Total Liabilities                                                 $

Other Assets (Describe in Section 5)                              $                 Net Worth                                                         $

Total                                                             $                 Total                                                             $
Section 1. Source of Income                                                         Contingent Liabilities
Salary                                                            $                 As Endorser or Co-Maker                                           $
Net Investment Income                                             $                 Legal Claims & Judgements                                         $
Other Personal Property (Describe in Section 5)                   $                 Provision for Federal Income Tax                                  $
Other Income (Describe Below)*                                    $                 Other Special Debt                                                $
*Description of Other Income in Section 1.




Alimony or child support payments need not be disclosed in "Other Income" unless it is described to have such payments counted toward total income.

Section 2. Notes Payable to Bank & Others. (Use Attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
                                                  Original            Current        Frequency
Name and Addresses of Noteholder(s)                                                                        How Secured or Endorsed Type of Collateral
                                                  Balance             Balance        (monthly,




  S:\Lending\Eof\Eof Application Documents\EOF Personal Financial Statement.xls
                                                               Chris,




                                                               This note unprotected &


                                                               may be deleted prior to


                                                               passing it on to the user.
                                                               Rex




S:\Lending\Eof\Eof Application Documents\EOF Personal Financial Statement.xls
                                          (Blue (Un-Protected) Cells: User Input                   Red Cell: Spreadsheet Calculations)                                                         Chris,
                                                                                                                                                                                               To Up-Protect the Entire
WORC - Economic Opportunities Fund                                                                               PERSONAL FINANCIAL STATEMENT PG. 2                                            Sheet, Use Password: CC
                                                                                                                                                                                               (PW must be in Caps.)
Section 3. Stocks and Bonds. (Use Attachments if necessary. Each attachment must be identified as a part of this statement and signed.)                                                        This note unprotected &
   Number of                       Name of Securities                            Cost            Market Value                               Date of                             Total
                                                                                                                                                                                               may be deleted prior to
    Shares                                                                                     Quotation/Exchange                     Quotation/Exchange
                                                                                                                                                                                   0           passing it on to the user.
                                                                                                                                                                                   0           Also please check me on
                                                                                                                                                                                   0           the "Total" Equation in
   Section 4. Real Estate Owned.                 (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a part of this statement                    Cells I,J-7,8,9 to make sure I
                                                 and signed.)                                                                                                                                  understood this section
                                                                      Property A                                        Property B                                Property C                   correctly. Rex
Type of Property

Address

Date Purchased

Original Cost

Present Market Value

Name & Address of Mortgage Holder

Mortgage Account Number

Mortgage Balance

Amount of Payment per Month/Year

Status of Mortgage

Section 5. Other Personal Property and Other Assets. (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a
                                                                          part of this statement and signed.)




Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, such lien attaches.)




Section 7. Other Liabilities. (Describe in detail.)




Section 8. Life Insurance Held. (Give the amount and cash surrender value policies - name of insurance company and beneficiaries.)




    I authorize WORC-EOF/Lender to make inquiries as necessary to verify the accuracy of the statements made to determine my credit worthiness. I certify the above and the statements
contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE
statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General.
Signature                                                                 Date                                                  Social Security Number

Signature                                                                 Date                                                  Social Security Number




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