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As of: _______________________
| Cash on Hand & in Banks | $ |
|---|---|
| Savings Accounts | $ |
| IRA or Other Retirement Accounts | $ |
| Accounts & Notes Receivable | $ |
| Life Insurance (Cash Surrender Value) | $ |
| Stocks and Bonds | $ |
| Real Estate (Market Value) | $ |
| Automobiles (Present Value) | $ |
| Other Personal Property | $ |
| Other Assets | $ |
| TOTAL ASSETS | $ |
| Accounts Payable | $ |
|---|---|
| Notes Payable to Banks | $ |
| Auto Loans | $ |
| Installment Accounts (Credit Cards) | $ |
| Loan on Life Insurance | $ |
| Mortgages on Real Estate | $ |
| Unpaid Taxes | $ |
| Other Liabilities | $ |
| TOTAL LIABILITIES | $ |
| NET WORTH (Assets - Liabilities) | $ |
|---|