Statement of Assets and Liabilities
(as of  	 )
Assets	Date of Purchase	Account Number
(if relevant)	Current Market Value ($)	
Cash and Cash Equivalents				
Cash				
Checking accounts				
Savings accounts				
Money market accounts				
Other				
Subtotal				
Real Estate				
House/condo/co-op				
Vacation home				
Income properties				
Unimproved lot				
Other lot				
Subtotal				
Personal Property				
Motor vehicles				
Furniture				
Home furnishings				
Electronic equipment				
Computer equipment				
Jewelry				
Clothing				
Collections (coin, stamp, etc.)				
Animals				
Other				
Subtotal				
Investments and Miscellaneous Assets				
Life insurance (term cash value)				
Life insurance (whole policies)				
Stocks				
Bonds				
Mutual funds				
Annuities				
IRAs				
Keoghs				
401(k) plans				
Other retirement plans				
Partnerships				
Accounts receivable				
Other				
Subtotal				
Liabilities	Date Incurred	Account Number	Total Balance
Due ($)	
Secured				
Mortgage				
Mortgage				
Deeds of trust				
Home equity loans				
Liens				
Motor vehicle loans				
Bank loans				
Personal loans				
Other				
Subtotal				
Unsecured				
Student loans				
Bank loans				
Personal loans				
Credit card balances				
Judgments				
Taxes				
Support arrears				
Other				
Subtotal				

Net Worth Summary
Total Assets	$		
Cash Subtotal			
Real Estate Subtotal			
Personal Property Subtotal			
Investments Subtotal			
Total Assets		$	
Total Liabilities			
Secured Subtotal			
Unsecured Subtotal			
Total Liabilities		$	
Net Worth			
(Assets minus liabilities)		$