Personal Financial Statement Worksheet Template Page 3
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4Personal Financial Statement
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Page
SUPPLEMENTARY SCHEDULES
SCHEDULE 1 - BANKING RELATIONSHIPS
Name & Location
Account Number
Checking
Savings
Retiremen
Collateral
High
of Institution
Balances
Balances
t Funds
Credit
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
SCHEDULE 2 - SECURITIES (GOV’T AND MARKETABLE)
No. Shares
Source of
Registered in Name
% Stock
or Face
Description
Cost
Market Value
Valuation
of
Pledged?
Value
$
$
$
$
$
$
$
$
SCHEDULE 3 - NON-MARKETABLE SECURITIES
Description
No. Shares
No. Shares
Book Value
Financial
Total Value
Registered in Name
Owned
Outstanding
Per Share
Statement
of
Date
$
$
$
$
$
$
$
$
SCHEDULE 4 - LIFE INSURANCE COVERAGE
Face
Insurance
Owner of Policy
Name of Beneficiary
Total
Policy
Yearly
Is Policy
Value
Company
C.S.V.*
Loans
Premium
Assigned
?
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
*Cash Surrender Value
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