Section 2. Notes Payable to Bank and Others.
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
(Use attachments if necessary. Each attachment must be identified as a part of
this statement and signed.)
Description of Other Income in Section 1.
Section 1.
(Describe in Section 2)
Mo. Payments
Mo. Payments
(Describe in Section 4)
(Describe in Section 6)
(Describe in Section 7)
LIABILITIES
(Complete Section 8)
(Describe in Section 3)
(Describe in Section 4)
(Describe in Section 5)
(Describe in Section 5)
Cash on hands & in Banks
Savings Accounts
IRA or Other Retirement Account
Accounts & Notes Receivable
Life Insurance-Cash Surrender Value Only
Stocks and Bonds
Real Estate
Automobile-Present Value
Other Personal Property
Other Assets
ASSETS
U.S. SMALL BUSINESS ADMINISTRATION
PERSONAL FINANCIAL STATEMENT
SBA Form 413 (2-94) Use 5-91 Edition until stock is exhausted. Ref: SOP 50-10 and 50-30
As of , 19
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning
20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.
Name Business Phone
Residence Address Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
(Omit Cents)
(Omit Cents)
Accounts Payable
Notes Payable to Banks and Others
Installment Account (Auto)
Installment Account (Other)
Loan on Life Insurance
Mortgages on Real Estate
Unpaid Taxes
Other Liabilities
Total Liabilities
Net Worth
TotalTotal
Contingent Liabilities
As Endorser or Co-Maker
Legal Claims & Judgments
Provision for Federal Income Tax
Other Special Debt
Salary
Net Investment Income
Real Estate Income
Other Income (Describe below)*
Source of Income
Name and Address of Noteholder(s)
How Secured or Endorsed
Type of Collateral
(tumble)
Frequency
(monthly,etc.)
Original
Balance
Current
Balance
Payment
Amount
This form was electronically produced by Elite Federal Forms, Inc.
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(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part
of this statement and signed.)
Property A
Property B
Property C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name &
Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)
Section 7. Other Liabilities. (Describe in detail.)
Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)
(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms
of payment and if delinquent, describe delinquency)
Section 3.
PLEASE NOTE: The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments
concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business
Administration, Washington, D.C. 20416, and Clearance Officer, Paper Reduction Project (3245-0188), Office of Management and Budget,
Washington, D.C. 20503.
I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above
and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining
a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General
(Reference 18 U.S.C. 1001).
Signature: Date: Social Security Number:
Signature: Date: Social Security Number:
Number of Shares Name of Securities Cost
Market Value
Quotation/Exchange
Date of
Quotation/Exchange
Total Value
Section 5.
Section 4.
