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As of ________________________________,  20 _____
Assets
cd
Current Assets     (Net Values)
cd Cash $ ____________________ cd
cd Petty Cash $ ____________________ cd
cd Accounts Receivable $ ____________________ cd
cd Inventory $ ____________________ cd
cd Short-Term investment $ ____________________ cd
cd Prepaid Expenses $ ____________________ cd
cd
cd Long-term investments $ ____________________ cd
cd
Fixed assets
cd Land $ ____________________ cd
cd Buildings $ ____________________ cd
cd Improvements $ ____________________ cd
cd Equipment $ ____________________ cd
cd Furniture $ ____________________ cd
cd Automobile/vehicles $ ____________________ cd
cd
Other Assets (List)
cd
cd 1. ____________________ $ ____________________ cd
cd 2. ____________________ $ ____________________ cd
cd 3. ____________________ $ ____________________ cd
cd
Total Assets cd $ ____________________
cd
Liabilities
cd
Current Liabilities (within 12 months)
cd Accounts Payable $ ____________________ cd
cd Notes Payable $ ____________________ cd
cd Interest Payable $ ____________________ cd
cd
Taxes Payable
cd Federal Income tax $ ____________________ cd
cd State Income tax $ ____________________ cd
cd Self-employment tax $ ____________________ cd
cd
Continued on next page . . .

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