Personal Financial Statement "*" indicates required fields Step 1 of 12 8% Personal Financial Statement as of:* MM slash DD slash YYYY Individual InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position or Occupation*Number of Years at Position or Occupation*Name of Business*Address of Business* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Residential Phone*Business Phone*Email* Date of Birth* MM slash DD slash YYYY Other Party InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position or Occupation*Number of Years*Name of Business*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Residential Phone*Business Phone*Email* Date of Birth* MM slash DD slash YYYY AssetsCurrent Assets (Readily Convertible to Cash)Cash and Savings*Securities Owned*MarketableCertificates of Deposit*Receivables due from others*Less than 1 yearCash Value-Life Insurance*Other Current Assets*Total Assets*Non Current AssetsReal Estate Owned*Investments*Non-MarketableReceivables*1 year or longerRetirement Funds*Personal Property*Vehicles*Business Ventures*Other Assets*Annual IncomeSalary, Bonus, and Commissions*Dividends & Interest*Rental and Lease Income*NetOther Party's Income*Other Income*Income from alimony, child support, need not be revealed if you do not choose to rely on it for repayment of this obligationTotal* LiabilitiesCurrent Liabilities (Due within 12 months)Notes Payable*Less than 1 yearAccounts Payable*eg. Charge cards/accountsTaxes and Interest Payable*Total current Liabilities:*Other current Liabilities:*Total Current Liabilities*Non Current Liabilities (Term Debt)Intermediate Term Liabilities*eg. Installment LoansLong Term Liabilities*eg. Real Estate LoansOther Liabilities*Contingent Capital Gains Tax Liability*Total Liabilities*Net Worth*Total Liabilities & Net Worth*Estimate of Annual ExpendituresMortgage/Rental payments*Real estate taxes and assessments*Taxes*Federal/State/LocalInsurance Payments*Other contract payments*car, charge cards, etc.Alimony, child support, maintenance*Other Expenditures*Total* SCHEDULE A: Cash and/or SavingsList*Account DescriptionInstitution NameIn the Name(s) ofAmount Add RemoveTotal* SCHEDULE B: Securities/Investments Owned (stocks, bonds, mutual funds, etc.)List*Number of Shares of Bond AmountDescriptionIn Name ofAre These Registered, Pledged, or Held by Others?Present ValueMarketable or Non Marketable Add RemoveTotal Registered, Pledged, or Held By Others*Total Present Value* SCHEDULE C: Life InsuranceList*InsuredInsurance CompanyBeneficiaryFace Value of PolicyCash ValueLoans Add RemoveTotal Cash Value*Total Loans* SCHEDULE D: Real Estate OwnedList*Address and Type of PropertyTitle in the Name(s) ofMonthly IncomeCostYear AcquiredPresent Market ValueAmount of Insurance Add RemoveTotal Present Market Value* SCHEDULE E: Retirement Plan ScheduleList*% VestedCompany NameAccount NumberManner of Payout (Annuity, Lump Sum, etc.)Distribution DateBeneficiaryAmount Add Remove SCHEDULE F: Business VenturesList*Business Venture in which you are a Principal or PartnerYour Position/Title in BusinessNature of BusinessYears in BusinessYour % of OwnershipNet Worth of BusinessPresent Net Value of Your Investment Add Remove SCHEDULE G: Mortgages or Liens on Real EstateList*Address and Type of PropertyTo Whom Payable1st or 2nd LienHow PayableInterest RateMaturity DateUnpaid Balance Add Remove SCHEDULE H: Loans Payable to Banks & Others and Installment Contracts PayableList*To Whom PayableAddressCollateral or UnsecuredHow PayableMaturity DateUnpaid Balance Add RemoveTotal Unpaid Balance* Income Tax Returns Filed Through (Date):* MM slash DD slash YYYY Are any returns currently being audited or contested? If so, what year?*YesNoIf yes, what year?*In the last 7 years, have you any unsatisfied judgements?*YesNoIn the last ten years, have you been declared bankrupt?*YesNoIn the last 7 years, have you had property foreclosed upon or given title or deed in lieu thereof?*YesNoAre you a co-maker, guarantor or endorser on a note?*YesNoIf yes, denote amount*Are you a party in a lawsuit?*YesNoAre you obligated to pay alimony, child support or separate maintenance?*YesNoDo you have a will in place?*YesNoDo you have an estate plan in place?*YesNoName of Attorney* First Last Phone Number of Attorney*Name of Accountant* First Last Phone Number of Accountant*The undersigned acknowledge and understand that the surety is relying on the information provided herein in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents, warrants and certifies that the information provided herein is true, correct and complete. Unless notified of any change, we will continue to rely upon the statement herein as a true, complete and accurate statement. The undersigned authorize any person or consumer reporting agency to give the surety any information it may have on the undersigned.*