Filetype Excel XLSX | Posted on 14 Aug 2022 | 3 years ago
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237x Filetype XLSX File size 0.02 MB Source: ndbf.nebraska.gov
Sheet 1: Page One
| Personal Financial Statement | ||||||
| Name: | ||||||
| Balance sheet as of (date): | ||||||
| Please Complete and Print Both Page One and Page Two | ||||||
| Joint | ||||||
| Individual | ||||||
| Please fill in all blanks. Insert 0 if appropriate. | Please fill in all blanks. Insert 0 if appropriate. | |||||
| ASSETS | LIABILITIES | |||||
| Current Assets | Current Liabilities | |||||
| Cash | Accounts Payable (Sch F) | $0 | ||||
| Accounts & Notes Receivable | Short-Term Notes (Sch G) | $0 | ||||
| Inventory | Credit Card Debt (Sch H) | $0 | ||||
| Liquid Investments (Sch A) | $0 | Interest Payable | ||||
| Prepaid Expenses | Taxes Payable | |||||
| Other Current Assets | Other Current Liabilities | |||||
| Total Current Assets | $0 | Total Current Liabilities | $0 | |||
| Non Current Assets | Long-term Liabilities | |||||
| Long-Term Investments (Sch B) | $0 | Mortgages (Sch D) | $0 | |||
| Cash Value Life Insurance | Other long-term liabilities (Sch I) | $0 | ||||
| Retirement Accounts (Sch C) | $0 | |||||
| Total Long-Term Liabilities | $0 | |||||
| Real Estate (Sch D) | $0 | |||||
| Auto | Total Liabilities | $0 | ||||
| Other Assets (Sch E) | $0 | |||||
| Total Non Current Assets | $0 | Net Worth | $0 | |||
| TOTAL ASSETS | $0 | TOTAL LIABILITIES & EQUITY | $0 | |||
| This Personal Financial Statement was prepared for the Nebraska Department of Banking and Finance to be used in conjunction with executive officer licensing requirements. The above is accurate and complete to the best of my knowledge. | ||||||
| I understand any misstatements are subject to administrative actions which may include prohibition from receiving, or loss of, an executive officer's license. | ||||||
| _____________________________________________________________________ Date: _______________ | ||||||
| (Signature of Individual Applicant) | ||||||
| (Original signature required for application submission) | ||||||
| REV 04/2016 | ||||||
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