Personal Financial Statement Buyer Package: Personal Financial Statement PERSONAL FINANCIAL STATEMENT STRICTLY CONFIDENTIAL Personal Financial Statement Name First Last Address Street Address 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 PhoneFaxEmail AssetsCash on hand in Banks U.S. Government Securities Loans, Notes and Accounts Receivable (what people owe YOU) Cash Surrender of Life Insurance (not death benefit amount) Value of Business(es) Presently Owned Other Stocks and Bonds Real Estate Owned – Personal Residence (fair market value) Real Estate Owned – Investment Property (fair market value) Vehicles: Number Owned (include value of all) Other Assets:Liabilities and Net WorthNotes Payable (amount YOU owe other than real estate loans) Liens on Real Estate – Personal Residence (amount you still owe) Liens on Real Estate – Investment Property (amount you still owe) Vehicle Loan(s) Sources of Income (per year)Salary from Present Employment Dividends and Interest (Income from these per year) Bonuses and Commissions Real Estate Income (such as Rental Income) Other Income:Signature The signature below certifies that the above information is true and correct and acknowledge receipt of the Personal Financial Statement.Date MM slash DD slash YYYY CAPTCHAType the five characters in the box above.
