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PERSONAL FINANCIAL STATEMENT
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 Name: Name of Spouse:
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 Email: Email:
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 Cell Ph: Cell Ph:
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 Employer: Employer:NoneYears:
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 Occupation:Years: Occupation:
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 Credit Scores:
TransUnion:
 Credit Scores:TransUnion:
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Experian:Experian:
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Equifax:Equifax:
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Innovis:Innovis:
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Partner or Officer in any other venture? ______________________
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Are any assets pledged? ____________________
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Have you ever made a compromise settlement or taken bankruptcy? Explain.
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ASSETS(omit cents)LIABILITIES(omit cents)
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 Cash on Hand & in Banks (Schedule 1)$0MORTGAGES
PAYABLE
(Schedule 7)		 Homestead
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 U.S. Government Securities Other Wholly-Owned R/E$0
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 Accounts, Loans & Notes Receivable (Schedule 2)$0 Partially Owned R/E$0
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 Net Cash Value of Life Ins. & Annuities (Schedule 3)$0NOTES
PAYABLE
(Schedule 6)		 To Relatives
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 Other Stocks & Bonds (Schedule 4)$0 To Others
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 Deferred Comp. & Retirement Plans (Schedule 5)$0
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 Personal Property
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 Equipment & Other Business AssetsTAXES
OWING		 Income Taxes
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 Automobiles - Number ( )) Other Taxes
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REAL
ESTATE
(Schedule 7)		 Homestead Accounts Payable
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 Other Wholly-Owner R/E$0 Estimated Credit Card Balance
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 Partial Ownership in R/E$0Other Liabilities (Schedule 8)$0
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 Other Assets (Itemize)
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 TOTAL LIABILITIES$0
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 NET WORTH$0
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 TOTAL ASSETS$0 TOTAL LIABILITIES AND NET WORTH$0
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 Total Contingent Liabilities (Schedule 9)$0
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INCOME/EXPENSE INFORMATION
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SOURCES OF CASH(monthly)USES OF CASH(monthly)
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RECURRING Salary & WagesEXPENSES Income Taxes & FICA
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 Commissions, Bonus, Etc. Other Payroll Deductions
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 Dividends & Interest Living Expenses & Misc.
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 Real Estate Income (Schedule 7)$0 Rental Expenses (Schedule 7)$0
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 Other Business Income Other Capital Expenditures
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 Other Other Business Expenses
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Vacancy, operating expense & repairs
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SUBTOTAL$0SUBTOTAL$0
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NON-RECURRING Commissions, Bonus, Etc.DEBT SVC Scheduled Pymts. On Debts
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 Sale of Assets Other Interest
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 Tax Refund Other Principal
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 Other Contingent Liab.
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SUBTOTAL$0TOTAL CASH USES$0
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TOTAL CASH SOURCES$0NET CASH FLOW $0
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 The above financial and supporting schedules present a true, complete and correct statement of my financial condition as of the date shown. I understand that misrepresenting information on this statement is a criminal offense under federal law punishable by a fine and/or imprisonment.
I will notify you in writing of any material unfavorable change in my financial condition. In the absence of such notice, you may consider this a continuing statement and substantially correct. You are authorized to contact any appropriate third parties for the purpose of verifying any stated information herein or at any time furnished by me to you, and obtaining credit information at any time from any of my creditors and or credit reporting agencies. This financial statement and any other information furnished to you shall be your property.
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Date:1/28/2026Signed:
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Signed:
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