FORM TO DETERMINE NET WORTH
AS OF (DATE)____________

ASSETS

Liquid Assets



Cash and Checking _________________________ Savings accounts __________________________ Money markets _____________________________ Life insurance-cash value _________________ U.S. savings bonds ________________________ Brokerage accounts ________________________ Other _____________________________________ Total Liquid Assets ________________________________ Marketable Invested Assets Common stocks _____________________________ Mutual Funds ______________________________ Corporate bonds ___________________________ Municipal bonds ___________________________ Certificates of deposit ___________________ Other _____________________________________ Total Marketable Invested Assets ___________________ Nonmarketable Invested Assets Business interests ________________________ Investment real estate ____________________ Pension accounts __________________________ Thrift plan accounts ______________________ Preferred stocks __________________________ Other _____________________________________ Total Nonmarketable Invested Assets ________________ Use Assets (use fair market value) Residence _________________________________ Vacation home _____________________________ Automobile ________________________________ Boat ______________________________________ Furs, jewelry _____________________________ Furniture _________________________________ Other personal property ___________________ Total Use Assets ___________________________________

LIABILITIES

Current Liabilities

Charge accounts/credit cards ______________

Other outstanding bills ___________________

Short term loans __________________________

Outstanding taxes _________________________
        
		  Total Current Liabilities __________________________
      
Long Term Liabilities
               
Mortgage on residence ___________________________

Mortgage on investment real estate ______________

Auto loans ______________________________________

Other bank loans ________________________________
                
Margin loans ____________________________________
                
Life insurance policy loans _____________________

Other ___________________________________________
        
		  Total Long Term Liabilities ________________________

Family Net Worth 
(subtract liabilities from assets)___________________________________

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