Personal Financial Statement

BORROWER		CO-BORROWER
Monthly Income		Monthly Income
Gross Wages / Frequency of Pay	$	Gross Wages / Frequency of Pay	$
Unemployment Income	$	Unemployment Income	$
Child Support / Alimony	$	Child Support / Alimony	$
Disability Income/ SSI	$	Disability Income/ SSI	$
Rents Received	$	Rents Received	$
Other	$	Other	$
Less: Federal and State Tax, FICA	$	Less: Federal and State Tax, FICA	$
Less: Other Deductions (401K, etc.)	$	Less: Other Deductions (401K, etc.)	$
Commissions, bonus and self-employed income	$	Commissions, bonus and self-employed income	$
Total (Net income)	$	Total (Net income)	$
Monthly Expenses		Assets
Mortgages / Liens	$	Type	Estimated Value
Auto Loan(s)	$	Checking Account(s)	$
Auto Expenses / Insurance	$	Saving / Money Market	$
Credit Cards / Installment Loan(s) (total minimum payment for both per month)	$	Stocks / Bonds / CDs	$
Health Insurance (not withheld from pay)	$	IRA / Keogh Accounts	$
Medical (Co-pays and Rx)	$	401k / ESPO Accounts	$
Child Care / Support / Alimony	$	Home Value	$
Food / Spending Money	$	Other Real Estate #	$
Water / Sewer / Utilities / Phone	$	Cars #	$
HOA/Condo Fees/Property Maintenance	$	Life Insurance (Whole Life not Term)	$
Life Insurance Payments (not withheld from pay)	$	Other	$
Total	$	Total	$

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