Name:
Date:
|
Section A:
Accounts, Investments, Real Estate, Business Interests.
Enter items and amounts in each area. |
|
1. Bank Accounts
(checking, savings):
|
|
2. Stocks, Bonds, Mutual Funds, etc:
|
3. IRA's, Annuities,
etc:
|
4. Real Estate:
|
|
5. Businesses:
|
6. Other:
|
|
|
Section
B: Life Insurance Policies. (Attach extra pages
as needed.)
1.
Company:
Policy
Number:
Insured:
Beneficiary:
Cash Value:
Amount of Policy:
2.
Company:
Policy
Number:
Insured:
Beneficiary:
Cash Value:
Amount of Policy:
|
|
Section C:
Personal Property. (List all property which
would have monetary value if it were sold. Use appraised values
or estimate value, as of this date.)
Total Value
of Personal Property:
|
|
Section D:
Your Debts. (List mortgages, car loans, credit
card debts, etc.)
1. Description:
Owed to:
Amount:
2.
Description:
Owed to:
Amount:
3. Description:
Owed to:
Amount:
Total
Amount of Debts:
|
|
Section E:
Available Assets. (To figure this, add the total
amounts of Sections A, B, and C. Enter this figure on line 4.
On line 5, enter the total amount of debts from Section D above.
Subtract line 5 from line 4. This is the Total Value of Assets
available to you now.)
1. Section A Total:
2. Section B
Total:
3. Section C
Total:
Total Assets:
Total Debts:
= Total Available Assets
|