Business Financial Statement - Texas Department of Banking

BUSINESS FINANCIAL STATEMENT

Name of Business: _____________________________ License Number: ___________________

Prepared By:

_____________________________ Title (Position): ___________________

Sole Proprietor: ________

Partnership: _________

Corporation: ___________

Statement of Financial Condition as of:

____________________, 20_____

CURRENT ASSETS:

ASSETS

Cash on Premises

Cash in Banks (Schedule 1a)

Certificates of Deposit (Schedule 1b)

Stocks, Bonds & Other Marketable Assets (Schedule 2) Accounts, Loans & Notes Receivable (Schedule 3) Advances to Employees

Prepaid Expenses (Schedule 4)

Other Current Assets (Itemize)

LIABILITIES AND NET WORTH CURRENT LIABILITIES:

Accounts Payable (Schedule 6) Accrued Interest on Borrowings Notes Payable ? Current Portion

Accrued Taxes on Real Estate (Schedule 7) Accrued Taxes/Other (Schedule 7) Other Current Payables (Itemize)

TOTAL CURRENT LIABILITIES

TOTAL CURRENT ASSETS

FIXED ASSETS: Real Estate & Buildings (Schedule 5) Less: Accumulated Depreciation Furniture, Equipment & Vehicles Less: Accumulated Depreciation Other Fixed Assets (Itemize) Other Long Term Assets (Itemize if over 5%of total)

TOTAL ASSETS

LONG TERM LIABILITIES: Notes Payable (Itemize)

Notes Payable on Real Estate (Schedule 5) Other Long Term Liabilities (Itemize)

TOTAL LONG TERM LIABILITIES

NET WORTH OR STOCKHOLDER'S EQUITY (Schedule 8) TOTAL LIABILITIES & NET WORTH

Assets pledged or hypothecated valued at $_____________ are pledged to secure notes or obligations aggregating $________________. I have additionally endorsed, guaranteed or am contingently liable for debts or others amounting to $________________.

Texas Department of Banking

SCHEDULES

Schedule 1. (a) Cash in Financial Institutions.

Name of Financial Institution and Address

Account in Name Of

Type of Account

Account Number

Balance

Schedule 1. (b) Certificates of Deposit.

TOTAL

Name of Financial Institution and Address

Account in Name Of

If Pledged, State to Whom

Maturity Date

Account Number Balance

Schedule 2. Stocks, Bonds & Other Marketable Assets.

TOTAL

Face Value Bonds Description No. Stock Shares of Security

Registered in Name of

Cost

Income Received

If Pledged,

Last Year

State to Whom

Present Market Value

Schedule 3. Accounts, Loans & Notes Receivable.

Name and Address of Debtor

Age of Debt

Description or Nature of Debt

TOTAL

Description of Security Held

Date Payment Expected

Amount Owing

Texas Department of Banking

TOTAL

Schedule 4. Prepaid Expenses.

Type of Prepaid

To Whom Paid

Expiration Date

Original Amount Current Balance

Schedule 5. Real Estate & Buildings.

Location or Street No. & Description

Mortgages or Liens

TOTAL

Unpaid Taxes

Due Dates &

Cost

Payment Amount Year

Amt.

Present Market Value

Schedule 6. Accounts Payable.

Nature of Account

Payable To

TOTAL

When Due

Amount Due

Schedule 7. Accrued Taxes.

Type of Tax

Payable To

TOTAL

When Due

Amount Due

TOTAL

Texas Department of Banking

Schedule 8. Net Worth or Stockholders' Equity.

Type Common Stock (____Shares) Preferred Stock Additional Paid-In Capital Retained Earnings

TOTAL

Amount

Texas Department of Banking

STATEMENT OF INCOME AND EXPENSES

For The Period _______________,20___ to ________________, 20___

INCOME: ________________________________ ________________________________ Other Income (Itemize) ________________________________ ________________________________

TOTAL INCOME

EXPENSES Advertising Cash (Over) Short Depreciation & Amortization Equipment Rental Insurance Interest & Bank Charges Legal, Audit, Bookkeeping Office Supplies Rent Salaries Security & Janitor Taxes & Payroll Utilities & Telephone Vehicle Expense Other Expenses (Itemize) _______________________________ _______________________________ _______________________________

____________________________ ____________________________ ____________________________ ____________________________ ____________________________

____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________

____________________________ ____________________________ ____________________________

__________________(+)

TOTAL EXPENSES

__________________(+)

NET OPERATING INCOME (LOSS)

__________________

OTHER INCOME (EXPENSES) (Itemize) _______________________________ _______________________________ _______________________________

_____________________________ _____________________________ _____________________________

TOTAL OTHER INCOME (EXPENSES)

__________________(+)

INCOME BEFORE TAXES

__________________

INCOME TAXES

__________________(-)

NET INCOME (LOSS)

__________________

Texas Department of Banking

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