Family Financial Statement
	Borrower	Coborrower	
Name:			
Address:			
			
Home phone number:			
Employer:			
Employer’s address:			
Work phone number:			

Worksheet 1: Income and Expenses

I. INCOME	Borrower ($)	Coborrower ($)	Total	
A. Monthly gross income				
1. Employment				
2. Public benefits				
3. Dividends				
4. Royalties				
5. Interest and other investment income				
6. Other (specify):				
				
B. Total monthly gross income				
				
II. MONTHLY EXPENSES				
A. Nonhousing				
1. Child care				
2. Clothing				
3. Food				
4. Insurance				
a. Auto				
b. Life				
c. Medical & dental				
5. Other medical				
6. Personal				
7. Education				
8. Taxes (nonhousing)				
9. Transportation				
10. Other (specify):				
				
B. Current 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 ($)	Coborrower ($)	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)