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Personal Financial Statement PDF
Personal Financial Statement
Personal Financial Statement
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Will a single person or a married couple be the receiver of this financial statement?
Individual or Couple:
Individual
Married
What day in the preparation of this financial statement?
Date Prepared:
MM slash DD slash YYYY
Who is the person for whom this Financial Statement is being prepared?
Individual Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Home Telephone Number:
Cell Phone Number:
PDF Preview
What are your date of birth and social security number?
How will you enter your Social Security Number?:
For your security, please write the Social Security Number on your finished document
Date of Birth:
MM slash DD slash YYYY
What are the name, address, and phone number of your spouse?
Spouse Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Home Telephone Number:
Cell Phone Number:
What is the social security number and birthdate of your spouse?
How will you enter your spouse's Social Security Number?:
For your security, please write the Social Security Number on your finished document
Spouse's Date of Birth:
MM slash DD slash YYYY
PDF Preview
What resources must you list in this financial statement?
Select all assets that apply for you:
Checking accounts
Savings accounts
Retirement plans
Stocks
Bonds
Life insurance
Personal residence real estate
Household furnishings
Business property and real estate
Other real estate
Vehicles
Mutual funds
Trusts
Annuity
Accounts receivable
Certificate of deposit
Notes receivable
Jewelry
Boats
Recreational equipment
Other assets
What is the value of your Checking Account(s)?
Value ($):
What is the value of your Savings Account(s)?
Value ($):
What is the value of your Retirement Plan(s)?
Value ($):
What is the value of your Stocks?
Value ($):
What is the value of your Bond(s)?
Value ($):
What is the value of your Life Insurance?
Value ($):
What is the value of your Personal Residence?
Value ($):
What is the value of your Household Furnishings?
Value ($):
What is the value of your Business Property and Real Estate?
Value ($):
What is the value of your Other Real Estate?
Value ($):
What is the value of your Vehicle(s)?
Value ($):
What is the value of your Mutual Funds?
Value ($):
What is the value of your Trust(s)?
Value ($):
What is the value of your Annuities?
Value ($):
What is the value of your Accounts Receivable?
Value ($):
What is the value of your Certificates of Deposit?
Value ($):
What is the value of your Notes Receivable?
Value ($):
What is the value of your Jewelry?
Value ($):
What is the value of your Boat(s)?
Value ($):
What is the value of your Recreational Equipment?
Value ($):
What is the value of your Other Assets?
Value ($):
Which of the following assets does your spouse have to include in this Financial Statement?
Select all assets that apply for your spouse:
Checking accounts
Savings accounts
Retirement plans
Stocks
Bonds
Life insurance
Personal residence real estate
Household furnishings
Business property and real estate
Other real estate
Vehicles
Mutual funds
Trusts
Annuity
Accounts receivable
Certificate of deposit
Notes receivable
Jewelry
Boats
Recreational equipment
Other assets
What is the value of your spouse's Checking Account(s)?
Value ($):
What is the value of your spouse's Savings Account(s)?
Value ($):
What is the value of your spouse's Retirement Plan(s)?
Value ($):
What is the value of your spouse's Stocks?
Value ($):
What is the value of your spouse's Bond(s)?
Value ($):
What is the value of your spouse's Life Insurance?
Value ($):
What is the value of your spouse's Personal Residence?
Value ($):
What is the value of your spouse's Household Furnishings?
Value ($):
What is the value of your spouse's Business Property and Real Estate?
Value ($):
What is the value of your spouse's Other Real Estate?
Value ($):
What is the value of your spouse's Vehicle(s)?
Value ($):
What is the value of your spouse's Mutual Funds?
Value ($):
What is the value of your spouse's Trust(s)?
Value ($):
What is the value of your spouse's Annuities?
Value ($):
What is the value of your spouse's Accounts Receivable?
Value ($):
What is the value of your spouse's Certificates of Deposit?
Value ($):
What is the value of your spouse's Notes Receivable?
Value ($):
What is the value of your spouse's Jewelry?
Value ($):
What is the value of your spouse's Boat(s)?
Value ($):
What is the value of your spouse's Recreational Equipment?
Value ($):
What is the value of your spouse's Other Assets?
Value ($):
PDF Preview
What liabilities do you have to include in this Financial Statement?
Select all liabilities that apply for you:
Personal Residence Mortgage or Rent Owed
Home Equity Loan
Other Mortgage
Vehicle Loans
Credit Card Debt
Student Loans
Other Liabilities
Indicate the remaining balance of each of your liabilities in money.
What is the balance of your Mortgage or Rent owed?:
What is the balance of your Home Equity Loan?:
What is the balance of your Other Mortgage?:
What is the balance of your Vehicle Loans?:
What is the balance of your Credit Card Debt?:
What is the balance of your Student Loans?:
What is the balance of your Other Liabilities?:
What debts is your spouse required to list in this financial statement?
Select all liabilities that apply for your spouse
Personal Residence Mortgage or Rent Owed
Home Equity Loan
Other Mortgage
Vehicle Loans
Credit Card Debt
Student Loans
Other Liabilities
Provide the balance (in dollars) for each of your spouse's liabilities.
What is the balance of your spouse's Mortgage or Rent owed?:
What is the balance of your spouse's Home Equity Loan?:
What is the balance of your spouse's Other Mortgage?:
What is the balance of your spouse's Vehicle Loans?:
What is the balance of your spouse's Credit Card Debt?:
What is the balance of your spouse's Student Loans?:
What is the balance of your spouse's Other Liabilities?:
PDF Preview
Are you currently employed?
Employed?:
Yes
No
What is the name of your current Employer?:
What sources of monthly income must you provide in this worksheet?
Select all income sources that apply for you:
Monthly Salary Wage
Investment Accounts
Alimony
Child Support
Trusts
Other Income Sources
What is the monthly income (in dollars) you earn from each of your income sources?
What is the monthly income from your Salary or Wages?:
What is the monthly income from your Investment Accounts?:
What is the monthly income from your Alimony?:
What is the monthly income from your Child Support?:
What is the monthly income from your Trusts?:
What is the monthly income from your Other Income Sources?:
Is your spouse working right now?
Employed?:
Yes
No
What is the name of your spouse's current Employer?:
What sources of monthly income does your spouse need to list on this worksheet?
List Spouse Monthly Income Included:
Monthly Salary Wage
Investment Accounts
Alimony
Child Support
Trusts
Other Income Sources
What is the monthly income from your spouse's Salary or Wages?:
What is the monthly income from your spouse's Investment Accounts?:
What is the monthly income from your spouse's Alimony?:
What is the monthly income from your spouse's Child Support?:
What is the monthly income from your spouse's Trusts?:
What is the monthly income from your spouse's Other Income Sources?:
PDF Preview
What regular expenses must you list in this financial statement?
List Monthly Expenses Included:
Paid Alimony
Paid Child Care
Paid Child Support
Groceries
Healthcare and Medications
Housing Rent
Other Mortgage Loans
Auto Loans
Auto Insurance
Health Dental Insurance
Life Insurance
Other Insurance
Credit Cards
Student Loans
Other Expenses
What is your monthly expense for Paid Alimony?
Monthly Amount ($):
What is your monthly expense for Paid Child Care?
Monthly Amount ($):
What is your monthly expense for Paid Child Support?
Monthly Amount ($):
What is your monthly expense for Groceries?
Monthly Amount ($):
What is your monthly expense for Healthcare and Medications?
Monthly Amount ($):
What is your monthly expense for Housing or Rent?
Monthly Amount ($):
What is your monthly expense for Other Mortgage Loans?
Monthly Amount ($):
What is your monthly expense for Auto Loans?
Monthly Amount ($):
What is your monthly expense for Auto Insurance?
Monthly Amount ($):
What is your monthly expense for Health or Dental Insurance?
Monthly Amount ($):
What is your monthly expense for Life Insurance?
Monthly Amount ($):
What is your monthly expense for Other Insurance?
Monthly Amount ($):
What is your monthly expense for Credit Cards?
Monthly Amount ($):
What is your monthly expense for Student Loans?
Monthly Amount ($):
What amount do you spend each month on other expenses?
Monthly Amount ($):
What responsibilities does your spouse have to list in this financial statement for monthly expenses?
List Spouse Monthly Expenses Included:
Paid Alimony
Paid Child Care
Paid Child Support
Groceries
Healthcare and Medications
Housing Rent
Other Mortgage Loans
Auto Loans
Auto Insurance
Health Dental Insurance
Life Insurance
Other Insurance
Credit Cards
Student Loans
Other Expenses
What is your spouse's monthly expense for Paid Alimony?
Monthly Amount ($):
What is your spouse's monthly expense for Paid Child Care?
Monthly Amount ($):
What is your spouse's monthly expense for Paid Child Support?
Monthly Amount ($):
What is your spouse's monthly expense for Groceries?
Monthly Amount ($):
What is your spouse's monthly expense for Healthcare and Medications?
Monthly Amount ($):
What is your spouse's monthly expense for Housing or Rent?
Monthly Amount ($):
What is your spouse's monthly expense for Other Mortgage Loans?
Monthly Amount ($):
What is your spouse's monthly expense for Auto Loans?
Monthly Amount ($):
What is your spouse's monthly expense for Auto Insurance?
Monthly Amount ($):
What is your spouse's monthly expense for Health or Dental Insurance?
Monthly Amount ($):
What is your spouse's monthly expense for Life Insurance?
Monthly Amount ($):
What is your spouse's monthly expense for Other Insurance?
Monthly Amount ($):
What is your spouse's monthly expense for Credit Cards?
Monthly Amount ($):
What is your spouse's monthly expense for Student Loans?
Monthly Amount ($):
What is your spouse's monthly expense for Other Expenses?
Monthly Amount ($):
When did this financial statement become effective?
When will you sign this financial statement?:
MM slash DD slash YYYY
When will your spouse sign this financial statement?:
MM slash DD slash YYYY
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