Personal Financial Statement - Financial Security Bank Page 3
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4Round all amounts to the nearest $100. Please contact your banker if you need assistance completing the schedules.
Schedule 1
Cash, Savings, Certificates of Deposit, and Money Market Accounts
Name of Bank or Financial Institution
Type of Account
Acct. Balance
(use attachments if necessary)
Total $
0
Schedule 2
Stocks, Bonds, or Other Securities Owned
# of shares or
Type of account
Name on account
Current market
bonds
value
Listed
Unlisted
Listed
Unlisted
Listed
Unlisted
Listed
Unlisted
Listed
Unlisted
Listed
Unlisted
Listed
Unlisted
(use attachments if necessary)
Total $
0
Schedule 3
Retirement, 401K, Profit Sharing, Pension, IRA Accounts, Keogh
Name of Institution
Account Type
Amount Vested %
Account Balance
Loans
(use attachments if necessary)
Totals $
0
0
Schedule 4
Cash Value of Life Insurance (whole life only)
Insurance Company
Name Insured
Beneficiary
Face Value
Cash Value
Loans
Totals $
0
0
Schedule 5
Real Estate / Mortgages / Contract for deeds / Contracts Owned
Monthly
Purchase
Mortgage
Monthly
Rental
Maturity
Personal residence (homestead)
Lender/Creditor
Market Value
Property Address
Year
Price
Balance
Payment
Income
Date
Monthly
Other Real Estate (rental homes,
Purchase
Mortgage
Monthly
Rental
Maturity
cabin, vacation homes, etc.)
Lender/Creditor
Market Value
Property Address
Year
Price
Balance
Payment
Income
Date
Totals $
0
0
(use attachments if more space is needed)
Monthly
Commercial Real Estate,
Purchase
Mortgage
Monthly
Rental
Maturity
Investment Real Estate, Etc.
Lender/Creditor
Market Value
Property Address
Year
Price
Balance
Payment
Income
Date
(Indicate if property is sold on contract for deed by
Totals $
0
0
marking “C4D” next to the property address)
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