${input_2_16}
PERSONAL FINANCIAL STATEMENT
Prepared for ${input_2_26}
on ${input_2_19}
NAME: |
${input_2_26} |
ADDRESS: |
${input_2_32_1} |
|
${input_2_32_3} , ${input_2_32_4} ${input_2_32_5} |
HOME PHONE: |
${input_2_33} |
CELL PHONE: |
${input_2_34} |
SSN: |
|
BIRTHDATE: |
${input_2_38} |
DETAILED SUMMARY LISTING OF ASSETS
INDIVIDUAL ASSET INFORMATION |
AMOUNT |
Accounts Receivable: |
|
Annuity: |
|
Boats: |
|
Bonds: |
|
Business Property and Real Estate: |
|
Certificate of Deposit: |
|
Checking Accounts: |
|
Household Furnishings: |
|
Jewelry: |
|
Life Insurance: |
|
Mutual Funds: |
|
Notes Receivable: |
|
Other Assets: |
|
Other Real Estate: |
|
Personal Residence Real Estate: |
|
Recreational Equipment: |
|
Retirement Plans: |
|
Savings Accounts: |
|
Stocks: |
|
Trusts: |
|
Vehicles: |
|
INDIVIDUAL TOTAL ASSET VALUE: |
$0.00 |
DETAILED SUMMARY LISTING OF LIABILITIES
INDIVIDUAL LIABILITY INFORMATION |
AMOUNT |
Mortgage or Rent: |
|
Home Equity Loan: |
|
Other Mortgage: |
|
Vehicle Loans: |
|
Credit Cards: |
|
Student Loans: |
|
Other Liabilities: |
|
INDIVIDUAL TOTAL LIABILITIES: |
$0.00 |
DETAILED SUMMARY LIST OF MONTHLY INCOME ASSET
INDIVIDUAL MONTHLY INCOME |
MONTHLY AMOUNT |
Monthly Salary or Wages: |
|
Investment Accounts: |
|
Alimony: |
|
Child Support: |
|
Trusts: |
|
Other Income Sources: |
|
INDIVIDUAL TOTAL MONTHLY INCOME ASSET: |
$0.00 |
DETAILED SUMMARY LIST OF MONTHLY EXPENSE LIABILITY
INDIVIDUAL MONTHLY EXPENSES |
MONTHLY AMOUNT |
Paid Alimony: |
|
Paid Child Care: |
|
Groceries: |
|
Healthcare or Medications: |
|
Housing or Rent: |
|
Other Mortgage Loans: |
|
Auto Loans: |
|
Auto Insurance: |
|
Health or Dental Insurance: |
|
Life Insurance: |
|
Other Insurance: |
|
Credit Cards: |
|
Student Loans: |
|
Other Expenses: |
|
INDIVIDUAL TOTAL MONTHLY EXPENSE LIABILITY: |
$0.00 |
NET WORTH SUMMARY
TOTAL ASSETS: |
$0.00 |
TOTAL LIABILITIES: |
$0.00 |
TOTAL NET WORTH: |
$0.00 |
I , ${input_2_81} , hereby certify and warrant, to the best of my knowledge, that the aforementioned information contained within this Personal Financial Statement is true, accurate and complete.
DATE : ${input_2_19} |
||
${input_2_81} |