|
|
Cash
or Market Value |
| Cash deposit
toward purchase held by: |
$ |
| List
checking and savings accounts below |
Name &
address of Bank, S&L, or Credit Union
Acct
No |
Name &
address of Bank, S&L, or Credit Union
Acct
No. |
Name & address of
Bank, S&L, or Credit Union
Acct
No. |
Name &
address of Bank, S&L, or Credit Union
Acct
No. |
| Stocks &
Bonds(Company name/number & description)
|
$ |
Life insurance net
value
Face amount: $
|
$ |
| Subtotal Liquid
Assets |
$ |
| Real Estate owned
(enter market value from schedule of real estate owned)
|
$ |
| Vested interest in
retirement fund |
$ |
| Automobile owned(make
& year)
|
$ |
Other
Assets(itemize)
|
$ |
|
Total
Assets |
$ |
| Net Worth (Total Assets minus Total
Liabilities) $ | |
Liabilitities and Pledged Assets. List
the creditor's name, address and account number for all
outstanding debts, including automobile loans, revolving
charge accounts, real estate loans, alimony, child support,
stock pledges etc. Use continuation sheet, if necessary,
Indicate by (*) those liabilities which will be satisfied upon
sale of real estate owned or upon refinancing of the subject
property.
|
|
LIABILITIES |
Monthly Payment &
Months left to Pay |
Unpaid
Balance |
Name & address of
Company
Acct No. |
$Payt./Mos |
$ |
Name &
address of company
Acct No. |
$Payt./Mos |
$ |
Name & address of
Company
Acct No. |
$Payt./Mos |
$ |
Name & address of
Company
Acct No. |
$Payt./Mos |
$ |
Name & address of
Company
Acct No. |
$Payt./Mos |
$ |
Name & address of
Company
Acct No. |
$Payt./Mos |
$ |
| Alimony/Child Support/Separate Maintenance Payment owed
to:
|
$ |
|
| Job Related
Expenses(Childcare, union dues, etc.) |
$ |
|
Total Monthly
Payments |
$ |
| |
Total
Liabilities |
$ |
|
|
|
|
|
| |