Personal Financial Statement

Assets & Income

Enter current asset and income amounts. Use “0” if not applicable.
Note: You do not need to disclose alimony, child support, or separate maintenance unless you choose to use it for qualification.

Assets Overview*

	Estimated Value (USD)
Cash (hand & bank)
Savings
IRA / Retirement Accounts
Accounts & Notes Receivable
Life Insurance (CSV)
Stocks & Bonds
Real Estate
Automobiles (current value)
Other Personal Property (est. value)
Other Assets

Income Overview

Total Net Income
Other Income & Other Assets – Description
Assets Supporting Documents
Supporting Documents

Please attach bank statements, brokerage summaries, tax returns, or pay stubs that support the figures above.📌 Each file must:Be clearly labeled (e.g., “Brokerage - Jan 2025”). Support a value listed above. Be signed (if applicable)
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Liabilities

List all current outstanding debts, loans, and obligations. Enter total balances as of the statement date. Use “0” if not applicable.

Liabilities Overview*

	Outstanding Balance (USD)
Notes Payable (Banks & Others)
Credit Cards / Revolving Debt
Installment Loans – Auto
Installment Loans – Other
Loans on Life Insurance
Mortgages Payable (Real Estate)
Taxes Payable
Legal Claims & Judgments
As Endorser / Co-Maker
Other Liabilities

Total Liabilities ($)
Other Liabilities – Description*
Describe the nature of the obligation: business guarantees, deferred payments, private notes, etc.
Liabilities Supporting Documents

Upload any documents that verify the liabilities listed above (e.g., credit statements, mortgage balances, tax bills).
Upload Supporting Documents

Files must be clearly labeled (e.g., “Mortgage Payoff – Main Residence”), legible, and dated within the last 90 days. Signed or certified where applicable.
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Do you expect any material financial changes in the next 12 months? Examples: selling property, taking on new debt, large income change, etc.

YesNo
📝 If “Yes,” please explain below:

Section: Signature & Attestation

Final Step: Please review your entire submission carefully before signing. Your signature confirms that all provided information is complete and accurate to the best of your knowledge.
Signature Date*

MonthDayYear
Enter today’s date or the date of review and finalization.
Should be Empty:

Personal Financial Statement Form (PFS)