BUSINESS FINANCIAL STATEMENT - NV Contractors Board
BUSINESS FINANCIAL STATEMENT
If you need assistance in completing this form, you are encouraged to seek the advice of an accountant.
Applicant / Licensee Name:___________________________________________________________________________
Business financial statement of _________________________________________________________ ___________
(Name)
(State Organized)
Business Entity: Sole Proprietorship
Corporation
Limited Liability Company
Limited Partnership
General Partnership
_______________________________________________________________________________________________
Street Address
City
State
Zip
Phone Number
CURREN T ASSETS Cash ? on hand....................................................... Cash ? in banks (schedule 1)............................... Securities - stocks / bonds (schedule 2)..........
Accounts receivable (schedule 3)........................
Current notes receivable (schedule 4)............. Other current assets (schedule 5).....................
As Of ___________________________
Month / Date / Year
Dollars
CURREN T LI ABI LI TI ES Accounts payable (schedule 3)..........................
$0.00 $0.00 $0.00 $0.00
Taxes payable........................................................ Other current liabilities (schedule 5)................
Current portion notes payable..................... (portion of notes payable due within the next 12 months)
$0.00
Dollars $0.00
$0.00
Tot a l Cur r e nt Asse t s
FI XED ASSETS Real estate (schedule 6) Vehicles & equipment (schedule 7)................... Long term notes receivable (attach schedule) Other assets and investments (schedule 8)....
$0.00
Tot a l Cu r r e n t Lia bilit ie s
Dollars
LON G TERM LI ABI LI TI ES
$0.00 Real estate debt (schedule 6)...........................
$0.00 Other long-term debt (schedule 8)...............
Long term notes payable (schedule 9)..........
$0.00
$0.00 Dollars
$0.00
Total Fixed Assets TOTAL ASSETS
$0.00 $0.00
Total Long Term Liabilit ies TOTAL LI ABI LI TI ES EQUI TY
$0.00 $0.00 $0.00
Equity is total assets minus total liabilities Working capital is total current assets minus total current liabilities
Net Sales: Net Profit: Con t in ge n t Lia bilit ie s:
Nevada State Contractors Board Business Financial Statement Form Page 1 of 4
(Rev 12/05)
SUPPLEM EN TARY SCH ED ULES ( Note: I f space is insufficient, attach separate sheet with additional inform ation)
SCHEDULE 1 BANK ACCOUNTS
Name and address of bank(s)
Current balance
SCHEDULE 2 SECURITIES - STOCKS AND BONDS
Name of Security
TOTAL:
$0.00 Value
Accounts Receivable
TOTAL:
SCHEDULE 3 ACCOUNTS RECEIVABLE / ACCOUNTS PAYABLE
Amount
Accounts Payable
$0.00 Amount
TOTAL:
$0.00
Nevada State Contractors Board Business Financial Statement Form Page 2 of 4
TOTAL:
$0.00
(Rev 12/05)
SCHEDULE 4 NOTES RECEIVABLE
Name and Address of Debtor
Due Date
Amount
TOTAL:
SCHEDULE 5 OTHER CURRENT ASSETS / OTHER CURRENT LIABILITIES
Other Current Assets (Itemize)
Value
Other Current Liabilities (Itemize)
$0.00
Amount
Location / Description
TOTAL:
$0.00
SCHEDULE 6 REAL ESTATE
Mortgage or Lien Holder
Cost
TOTAL:
$0.00
Current
Amount
Market Value Encumbered
Monthly Payments
Description
TOTAL:
$0.00
$0.00
$0.00
$0.00
SCHEDULE 7 VEHICLES & EQUIPMENT
Year Manufactured
Book Value
Nevada State Contractors Board Business Financial Statement Form Page 3 of 4
TOTAL:
$0.00 (Rev 12/05)
SCHEDULE 8 OTHER ASSETS AND INVESTMENTS / OTHER LONG TERM DEBT
Other assets and investments (Itemize)
Value
Other long-term debt (Itemize)
Amount
TOTAL:
$0.00
SCHEDULE 9 NOTES PAYABLE
Name and Address To Whom Due* *
TOTAL:
$0.00
Maturity Date
Monthly Payment
Amount Owed
TOTAL:
$0.00
$0.00
* * I f you have list ed a note payable to a stockholder, is that stockholder w illing to subordinate the not e payable to all other creditors?
Yes - include a signed and notarized stipulation agreement stating that all sub contractors, suppliers and other creditors would be compensated prior to the stockholders receiving funds.
No
The information contained in this statement is for the purpose of establishing financial responsibility, in accordance with NRS 624.262, NRS 624.263 and NRS 624.264. I have carefully read and submitted the foregoing information provided on all the pages of this statement.
I hereby certify, under penalty of perjury that the information is presented as a true, accurate and complete statement of our financial condition on the date indicated.
Signature of Principal or Ow ner
Print Nam e
Date Signed
Pr iva cy N ot ice : Pursuant t o NR S 624. 110(2)-Except as otherwise re quired in NRS 6 24.327, c redit re ports, re ferences, financ ial information and data pertaining to a licensee's net worth are confidential and not open to public inspection.
Nevada State Contractors Board Business Financial Statement Form Page 4 of 4
(Rev 12/05)
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