Financial Summary
| Sources of Income | Year: | Year: | Year: | Year: | Year: |
|---|---|---|---|---|---|
| Salary | $ | $ | $ | $ | $ |
| Social security | |||||
| Dividends and interest | |||||
| Real estate income | |||||
| Business income | |||||
| Any assets transferred to relatives | |||||
| Total | $ | $ | $ | $ | $ |
| Current Year Assets | |
|---|---|
| Bank accounts and cash on hand | |
| Name of institution | Amount |
| $ | |
| Cash on hand | |
| Total | $ |
| Other real estate (exclude subject property) | |
| Parcel no./acreage/description | Market Value |
| $ | |
| Total | $ |
| Stocks, bonds and securities | |
| Description | Market Value |
| $ | |
| Total | $ |
| Other assets (vehicles, accounts receivable, etc.) | |
| Description | Market Value |
| $ | |
| Total | $ |
| Total Assets | $ |
| Current Year Liabilities | |
|---|---|
| Notes payable to banks, relatives and others | |
| Description | Monthly Pymt |
| $ | |
| Total | $ |
| Real estate mortgage payable | |
| Lender/type/maturity/property identification | Monthly Pymt |
| $ | |
| Total | $ |
| Unpaid medical expenses | |
| Medical facility/patient/illness | Monthly Pymt |
| $ | |
| Total | $ |
| Other debts (credit cards, utility payments, etc.) | |
| Description | Monthly Pymt |
| $ | |
| Total | $ |
| Total Liabilities | $ |