PERSONAL FINANCIAL STATEMENT OF

Transcription

1 OF SUBMITTED FOR CONSIDERATION BY THE TARRANT COUNTY BAIL BOND BOARD (Submit most recent available financial data use page 11 to provide explanatory notes to the Personal Financial Statement)

2 Date of Birth: Social Security Number City, State Zip: Business or Occupation: Phone No: Fax No: D.B.A. (Doing Business As): Home Home No: Cell: ASSETS, LIABILITIES, and NET WORTH (Summary of Pages 2 through 11) Reference Summary of Assets Page Amounts Cash Surrender Life Insurance See Page 2 $ Money in Banks See Page 3 Certificates of Deposit See Page 4 Stocks and Bonds See Page 5 Real Estate (Other than Homestead) See Page 6 Real Estate (Homestead) See Page 8 Personal Autos See Page 8 Personal Property (Miscellaneous) See Page 8 Business Assets (Other) See Page 7 Total Assets $ Summary of Liabilities Reference Page Amounts Liabilities/Secured (Homestead, autos, real estate, jewelry, etc See Page 9 $ Liabilities/Unsecured (Credit cards, Personal Loans, etc.) See Page 10 Total Liabilities $ Total Assets $ Less Total Liabilities Net Worth $ =========================== Page 1 of 13

3 Annual Income ANNUAL INCOME and CURRENT ANNUAL EXPENSES Amount Salary, Bonus and Commissions Dividends and Interest Rental and/or Lease Income (Net) Other Income (Explain) TOTAL INCOME Annual Expenses Mortgage Payments Other Major Expenses (Any expense paid by your personal salary and/or budget) List: TOTAL EXPENSES Amount $ Total Income $ Less Total Expenses NET INCOME $ Net Income for the previous 3 years: $ $ $ Life Insurance Name of Insured Beneficiary Insurance Co. Type of policy Total cash Total Loans Is policy Whole/Term Face Amt. surrender against policy assigned? Total Cash Surrender Amount $ ============= Page 2 of 13

4 Money in Banks Financial Institutions Account Number Type checking/savings Amount $ Contact Contact Contact Contact Contact TOTAL $ ============= Page 3 of 13

5 PERSONAL FINANCIAL ST`ATEMENT List all Certificates of deposit below use additional sheets if needed Financial Institutions Certificate Number Amount $ Assigned: No Yes To whom: Assigned: No Yes To whom: Assigned: No Yes To whom: Assigned: No Yes To whom: Assigned: No Yes To whom: Assigned: No Yes To whom: TOTAL $ ============= Page 4 of 13

6 Furnish copies of all Stocks and Bonds Registered in the Name of Number Pledged State to whom Stocks- Number of Shares, Bonds Face Cost Description of Stock/Bond: $ $ Present Market Brokerage: Description of Stock/Bond: Brokerage: Description of Stock/Bond: Brokerage: Description of Stock/Bond: Brokerage: Description of Stock/Bond: Brokerage: Page 5 of 13 TOTAL PRESENT MARKET VALUE $ =============

7 List All Real Estate Other Than Homestead Use additional pages if needed Real Estate-Other than Homestead Lien Holder Tax Description: Mortgage Balance $ Purchase Price $ Account No. Amount of Insurance $ $ Taxable Real Estate-Other than Homestead Lien Holder Tax Account # Description: Mortgage Purchase Amount of Balance Price Insurance Taxable Real Estate-Other than Homestead Lien Holder Tax Account # Description: Mortgage Purchase Amount of Balance Price Insurance Taxable Real Estate-Other than Homestead Lien Holder Tax Account # Description: Mortgage Purchase Amount of Balance Price Insurance Taxable Real Estate-Other than Homestead Lien Holder Tax Account # Description: Mortgage Purchase Amount of Balance Price Insurance Taxable TOTAL TAXABLE VALUE $ ========== Page 6 of 13

8 List Other Business Assets Below Business Assets Liability Asset Type of Business: Type of Business: Type of Business: Type of Business: Type of Business: Type of Business: Type of Business: Type of Business TOTAL $ =============== Page 7 of 13

9 Miscellaneous Personal Property Real Estate Homestead Name of Lien Holder Tax Account # Tax City: Description: City: Amount Owed Autos Personal Lien Holder Make: Model: City: Year: Amount Owed Make: Model: City: Year: Amount Owed Make: Model: Year: (1) Personal Property City: Amount Owed List and Describe Below (Household Furnishings, Jewelry, etc. (2) (3) (4) (5) Recap: Real Estate Homestead Autos Personal Personal Property $ TOTAL $ ============== Page 8 of 13

10 Liabilities/Secured (Homestead, Auto, Real Estate Jewelry, etc.) Use additional sheets if needed. Lien Holder Account Number Type of Collateral Original Note Payment Mo./Annual Remaining Liability Page 9 of 13 TOTAL REMAINING LIABILITY $ ==============

11 Liabilities/Unsecured (Credit Cards, Personal Loans, Contingent Liabilities, etc.) List account numbers only, do not list credit card numbers. Lien Holder Account Number Type of Collateral Original Note Payment Mo./Annual Remaining Liability Page 10 of 13 TOTAL REMAINING LIABILITY $ ==============

12 Explanation of Personal Financial Statement Page No. Note(s) Page 11 of 13

13 STATE OF TEXAS COUNTY OF TARRANT For the purpose of procuring a Tarrant County Bail Bond License for claims and demands against the undersigned, the undersigned submits the above as being a true and accurate statement of its financial condition on the following date, and agrees that if any changes occur that materially reduce the means or ability of the undersigned to pay all claims or demands against it, the undersigned will immediately and without delay notify the Tarrant County Bail Bond Board, and unless the Tarrant County Bail Bond Board is so notified, it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the undersigned as of the close of business on. All of your assets, liabilities, and income must be listed herein. Signature of Applicant Sworn to and Subscribed to before me this day of, 20 Notary Public In and for State Of Texas Page 12 of 13

14 Property description when real estate is used as surety The following listed property is being submitted by as being assessed on the records of, Texas, Tax Office. Lot Block Account Number LOCATION & DESCRIPTION Addition Street Address City Taxable Applicant - Surety Subscribed and sworn to before me this day of, 20 Notary Public In and for State Texas Page 13 of 13