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					Net Worth Statement
Passing It On: University of Wyoming and the Wyoming Department of Agriculture


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Enter your input values in shaded cells.

                               Schedules of Assets and Liabilities
Name                                                                          Date

                               Schedule A. Bank Accounts and Cash
                                                                                Names
Description/Account Number                                         Location   on Account   Owner     Value
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
Total                                                                                                        $0



                       Schedule B. Stocks and Bonds
                                                When
Description/Account number          Location   Acquired                         Shares     Owner     Value
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
Total                                                                                                        $0



                               Schedule C. Retirement Accounts
Description                                                                   Location     Held by   Value
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
Total                                                                                                        $0



                               Schedule D. Automobiles
Description                                                                      Title      Cost     Value
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
Total                                                                                                        $0



                               Schedule E. Life Insurance
Description                                            Beneficiary Location                Held by   Value
                                                                                                             $0
                                                                                                             $0
                                                                                                             $0
Total                                                                                                        $0
                       Schedule F. Real Estate
                                                              Year                  Market
Description/Location                  Size        Title     Acquired      Cost      Value
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
Total                                                                                        $0



                       Schedule G. Household Goods
Description                                   Location        Cost     Ownership     Value
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
Total                                                                                        $0



                       Schedule H. Accounts/Notes Receivable
                                      Year                              Payment
Description                         Acquired  Date Due     Debtor         Plan       Value
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
Total                                                                                        $0



                       Schedule I. Credit Cards, Charge Accounts
                                                  Interest                          Amount
Description                                         Rate    Creditor    Date Due   Remaining
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
                                                                                             $0
Total                                                                                        $0
              Schedule J. Automobile Loans
                                                              Individual or    Amount
Description                           Creditor             Joint Responsibility
                                                    Date Due                 Remaining
                                                                                      $0
                                                                                      $0
                                                                                      $0
                                                                                      $0
Total                                                                                 $0



              Schedule K. Accounts Payable
                                                              Individual or    Amount
Description                           Creditor             Joint Responsibility
                                                    Date Due                 Remaining
                                                                                      $0
                                                                                      $0
                                                                                      $0
                                                                                      $0
Total                                                                                 $0



              Schedule L. Mortgages on Property
                                                              Individual or    Amount
Description                           Creditor             Joint Responsibility
                                                    Date Due                 Remaining
                                                                                      $0
                                                                                      $0
                                                                                      $0
                                                                                      $0
Total                                                                                 $0



              Schedule M. Loans on Life Insurance
                                                              Individual or    Amount
Description                           Creditor             Joint Responsibility
                                                    Date Due                 Remaining
                                                                                      $0
                                                                                      $0
                                                                                      $0
                                                                                      $0
Total                                                                                 $0



              Schedule N. Unpaid Personal Taxes
Description                                                                   Value
                                                                                      $0
                                                                                      $0
                                                                                      $0
Total                                                                                 $0
                                                Schedule O. Other Personal Liabilities
                                                                                                                                                      Balance                  Accrued
 Source                                                                 Purpose                                                                        Owed                    Interest
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
                                                                                                                                                                    $0                      $0
 Total                                                                                                                                                              $0                      $0

Version 1.0
Date Printed:                 2/14/2012




The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political
beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Many materials can be made available in alternative formats for ADA clients. To file
a complaint of discrimination, write USDA, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964.
Net Worth Statement
Passing It On: University of Wyoming and the Wyoming Department of Agriculture
See Chapter 5: Taking Stock of the Present in binder for more information.

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Enter your input values in shaded cells.

 Name                                    0                                                                                                                                             Date             01/00/00
 Personal Assets                                                                Market Value                 Personal Liabilities                                                                  Market Value
  Bank accounts and cash (Sch. A)                                                                   $0        Credit card, charge accounts (Sched. I)                                                        $0
  Stocks and bonds (Sch. B)                                                                         $0        Automobile loans (Sched. J)                                                                    $0
  Retirement accounts (IRA) (Sched. C)                                                              $0        Accounts payable (Sched. K)                                                                    $0
  Automobile (present value) (Sched. D)                                                             $0        Mortgages on properties (Sched. L)                                                             $0
  Life insurance (cash value) (Sched. E)                                                            $0        Loans on life insurance (Sched. M)                                                             $0
  Real estate (Sch. F)                                                                              $0        Unpaid personal taxes (Sched. N)                                                               $0
  Household goods, clothing (Sched. G)                                                              $0        Other personal liabilities                                                                     $0
  Accounts/notes receivable (Sched. H)                                                              $0                                                                                                       $0
  Other personal assets                                                                             $0

 Total Personal Assets (a)                                                                          $0      Total Personal Liabilities (b)                                                                   $0
                                                                                                            Personal Net Worth (c) (a - b)                                                                   $0

 Total Debt-to-Asset Ratio                                                                          $0      Personal Net Worth Last Year (d)                                                                 $0
                                                                                                            Change in Personal Net Worth (e) (c-d)                                                           $0



Date Printed:                                             2/14/2012




The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political
beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Many materials can be made available in alternative formats for ADA clients.

				
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