sample saln
Post on 07-Oct-2015
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SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As ofJanuary 1, 2015
DECLARANT:
ADDRESS:
ASSETS, LIABILITIES AND NETWORTH
1. ASSETS
a. Real Properties
DESCRIPTIONKINDLOCATIONASSESSED VALUECURRENT FAIR MARKET VALUEACQUISITIONACQUISITION COST
(e.g. lot, house and lot, condominium, and improvements)(e.g., residential, commercial, industrial, agricultural and mixed used)YEARMODE
Subtotal: XXXX
b. Personal Properties
DESCRIPTIONYEAR ACQUIREDACQUISITION COST/AMOUNT
Cash in Bank2015 xxxxxx
Subtotal: -
TOTAL ASSETS (a+b):#VALUE!
2. LIABILITIES*
NATURENAME OF CREDITORSOUTSTANDING BALANCE
TOTAL LIABILITIES: -
NET WORTH: Total Assets less Total Liabilities =
I hereby certify that these are true and correct statements of my assets, liabilities, net worth.
Date:
(Signature of Declarant)
SUBSCRIBED AND SWORN to before me this _______ day of ____________________ , affiant exhibiting to me the above-stated government issued identification card.
(Person Administering Oath)
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