Personal_Financial_Statement_Template

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					                                                    Business Financial Statement
                                                                       SSN : 00x xx xxx

Assets                                              Amount             Liabilities                                Amount
Cash On Hand                                                           Personal Loans to banks
Stocks, Bonds                                                          Personal Loans to Relatives
401k                                                                   MBNA
Notes Receivable?
Real Estate Owned*                                                     Chase
Car 1
Car 2
Cash Value Life Insurance
Other Assets                                                           Other Overdue Bills                           $     -
                             2nd Property
                                                    $             -

                                    Total           $             -                             Total                $     -




Sources Of Income                                   Amount             Annual Expenses                            Amount         Monthly
                                                                       Income Tax                                  $       -
Patient Visits cash                                                    RE Rent                                                   $         -
Insurance paid claims                                                  Electric                                                  $         -
Product sales                                                          Heat                                                      $         -
Other Income                                                           Insurance for practice
                                                                       Cleaning
                                                                       Phones
                                                                       Internet


                                                    $             -

                                    Total           $             -                             Total                $     -




General Information:                                                   Personal Information

1. Are Any Assets Pledged to a loan:                mortgage           Business Description
2. Are you a defendant in a law suit.                                  Partner or Officer in any other venture?
3. Personal Bank Account                                               Number of Dependents?
4. Have you ever been declared Bankrupt?                               Do you currently have a will?
                                                                       If yes, who is the executor?

Schedule of Marketable Securities
Name                                                Description        In Name of                                                Market Value
401k or mutual fund or cd



Schedule of Real Estate Owned                                                                                                                  Mortgage
Descripton Of Property                              Date Acquired      Title in Name of                 Cost      Market Value                 Amount   Maturity




Schedule of Life Insurance Carried
Carrier                                             Amount             Beneficiary                      Cash Value                             Loans Against It?




Names Of Banks and Financial Institutions where credit has been Obtains
Description                                         Balance on Loan
Equipment Lease                                      $          1.00
etc                                                  $          1.00
a Loan                                               $          1.00
                                            Total    $          1.00
                                           Personal Financial Statement
                                                            SSN : 00x xx xxx

Assets                                     Amount           Liabilities                        Amount
Cash On Hand                                                Personal Loans to banks
Stocks, Bonds                                               Personal Loans to Relatives
401k                                                        MBNA
Notes Receivable?                                           Discover
Real Estate Owned*                                          Chase
Car 1                                                       Radio Shack
Car 2
Cash Value Life Insurance
Other Assets                                                Other Overdue Bills                $        -
                            2nd Property
                                           $        -

                                   Total   $        -                                 Total    $        -




Sources Of Income                          Amount           Annual Expenses                    Amount       Monthly
                                                            Income Tax                          $       -
Salary-                                                     RE Mortgage                                     $         -
Part time Income                                            RE Taxes                                        $         -
Real Estate Income                                          Insurance on Home                               $         -
Other Income                                                Tuition for children
                                                            Medical Insurance
                                                            Utilities (Heat and Electric)
                                                            Food and Clothing
                                                            Car Payments
                                                            Nanny
                                           $        -                        Cable/ Internet

                                   Total   $        -                                 Total    $        -
General Information:                                                  Personal Information

1. Are Any Assets Pledged to a loan:               mortgage           Occupation:       Husband/ wife
2. Are you a defendant in a law suit.                                 Partner or Officer in any other venture?
3. Personal Bank Account                                              Number of Dependents?
4. Have you ever been declared Bankrupt?                              Do you currently have a will?
                                                                      If yes, who is the executor?

Schedule of Marketable Securities
Name                                               Description        In Name of                                                Market Value
401k or mutual fund or cd


Schedule of Real Estate Owned                                                                                                              Mortgage
Descripton Of Property                             Date Acquired      Title in Name of               Cost        Market Value              Amount   Maturity




Schedule of Life Insurance Carried
Carrier                                            Amount             Beneficiary                    Cash Value                            Loans Against It?




Names Of Banks and Financial Institutions where credit has been Obtains
Description                                        Balance on Loan
Equipment Lease                                     $          1.00
etc                                                 $          1.00
a Loan                                              $          1.00
                                           Total    $          1.00

				
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