Statement of Assets and Liabilities Template by ehp17932

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									            STATEMENT OF PERSONAL ASSETS & LIABILITIES


NAME:       _____________________________________________________________________________________


ADDRESS:    _____________________________________________________________________________________




ASSETS                                  $       LIABILITIES                                $

PROPERTY:                                       MORTGAGES ETC:


VEHICLES:                                       VEHICLES LOANS ETC:


CASH AT BANK INVESTMENT                         OVERDRAWN BALANCE ON
ETC:                                            PERSONAL ACCOUNT ETC:



FURNITURE, HOUSEHOLD                            PERSONAL LOANS RE: FURNITURE
APPLIANCES AND PERSONAL                         ETC (INCLUDING CREDIT CARDS):
EFFECTS ETC:


OTHER ASSETS:
                                                OTHER LIABILITIES:



                 TOTAL ASSETS=                                 TOTAL LIABILITIES=



SURPLUS ASSETS OVER LIABILITIES = $…………………………………………


I/WE HEREBY CERTIFY THAT THE ABOVE IS A FULL AND TRUE STATEMENT OF MY/OUR

PERSONAL ASSETS AND LIABILITIES AS AT THE ………………………DAY OF

…………….………………..20……………




SIGNED ………………………………………                                ……………………..………………………

								
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