Family Financial Statement
	Borrower	Co-Borrower
Name: 	_________________________	________________________	
Address: 	_________________________	_________________________	
Home phone: 	_________________________	_________________________	
Employer: 	_________________________	_________________________	
Employer's address: 	_________________________	________________________	
Work phone: 	_________________________	_________________________	

Worksheet 1: Income and Expenses
I.	INCOME	Borrower ($)	Co-Borrower ($)	Total ($)
A.	Monthly gross income
1.	Employment	_____________	_____________	____________
2.	Public benefits 	_____________	_____________	____________
3.	Dividends	_____________	_____________	____________
4.	Royalties	_____________	_____________	____________
5.	Interest/investments 	_____________	_____________	____________
6.	Other (specify):
______________________	_____________	_____________	____________
B.	Total Monthly Gross Income	____________	_____________	____________
II.	Monthly expense	Borrower ($)	Co-Borrower ($)	Total ($)
A.	Nonhousing
1.	Child care	_____________	_____________	____________
2.	Clothing	_____________	_____________	____________
3.	Food	_____________	_____________	____________
4.	Insurance
a.	Auto	_____________	_____________	____________
b.	Life	_____________	_____________	____________
c.	Medical	_____________	_____________	____________
5.	Other medical 	_____________	_____________	____________
6.	Personal	_____________	_____________	____________
7.	Education	_____________	_____________	____________
8.	Taxes (nonhousing)	_____________	_____________	____________
9.	Transportation	_____________	_____________	____________
10.	Other (specify):
_______________________	_____________	_____________	____________
B.	Housing
1.	Mortgage	_____________	_____________	____________
2.	Taxes	_____________	_____________	____________
3.	Insurance	_____________	_____________	____________
4.	Utilities	_____________	_____________	____________
5.	Rent	_____________	_____________	____________
6.	Other (specify):
_______________________	_____________	_____________	____________
C.	Total Monthly Expenses	_____________	_____________	____________

Worksheet 2: Assets and Liabilities
I.	Assets (Cash or Market Value)	Borrower ($)	Co-Borrower ($)	Total ($)
A.	Cash & cash equivalents
1.	Cash	_____________	_____________	____________
2.	Deposits (list):
_______________________	_____________	_____________	____________
_______________________	_____________	_____________	____________
B.	Marketable securities
1.	Stocks/bonds (bid price) 	_____________	_____________	____________
2.	Other securities	_____________	_____________	____________
3.	Mutual funds	_____________	_____________	____________
4.	Life insurance	_____________	_____________	____________
5.	Other (specify):
_______________________	_____________	_____________	____________
_______________________	_____________	_____________	____________
C.	Total cash & marketable securities	_____________	_____________	____________
D.	Nonliquid assets
1.	Real estate	_____________	_____________	____________
2.	Retirement funds	_____________	_____________	____________
3.	Business	_____________	_____________	____________
4.	Motor vehicles	_____________	_____________	____________
5.	Other (specify):
_______________________	_____________	_____________	____________
_______________________	_____________	_____________	____________
E.	Total nonliquid assets	_____________	_____________	____________
F.	Total all assets	_____________	_____________	____________
II. Liabilities
A.	Debts
1.	Real estate loans	_____________	_____________	____________
2.	Student loans	_____________	_____________	____________
3.	Motor vehicle loans	_____________	_____________	____________
4.	Child or spousal support	_____________	_____________	____________
5.	Personal loans	_____________	_____________	____________
6.	Credit cards (specify): 
_______________________	_____________	_____________	____________
_______________________	_____________	_____________	____________
7.	Other (specify): 
_______________________	_____________	_____________	____________
_______________________	_____________	_____________	____________
B. Total liabilities	_____________	_____________	____________
III. NET WORTH
(Total assets minus total liabilities)	_____________	_____________	____________