Form Pdo-103 - Financial Statement
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1PDO-103
Financial Statement
Name
Minnesota Tax ID Number
Date of Financial Statement
Address
Filing Period
City
State
ZIP Code
CURRENT ASSETS (ACTUAL FIGURES ONLY - NO ESTIMATES)
CURRENT LIABILITIES (ACTUAL FIGURES ONLY - NO ESTIMATES)
Cash on Hand in Bank
$
Accounts Payable
$
Accounts Receivable
$
Notes Payable (due within 1 year)
$
Not more than 90 days old
$
Loans Payable (due within 1 year)
$
More than 90 days old
$
Notes Receivable
$
INVENTORIES
TAXES ACCRUED
Gasoline
Gal
$
.Gasoline Tax and Inspection Fees
$
Fuel Oil
Gal
$
Withholding Tax
$
Spec Fuel
Gal
$
Social Security Tax
$
Other
Gal
$
Other
$
Investments
$
Total Current Assets
Total Current Liabilities
$
$
FIXED ASSETS
OTHER LIABILITIES
Furniture and Fixtures
$
Mortgage Payable
$
Delivery Equipment
$
$
Bulk Plant and Equipment
$
Balance on notes and loans due
within twelve months of this
Buildings
$
financial statement
Land
$
Residence
$
Other
$
Other Assets
$
TOTAL ASSETS
TOTAL LIABILITIES
$
$
NET WORTH*
$
*To determine net worth subtract total
liabilities from total assets
TOTAL LIABILITY AND
$
NET WORTH
I hereby certify that the above is true and correct copy of my financial statement for the date shown.
Authorized Signature
Title
Date
(Rev. 8/17)
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Parent category: Financial