Form CORP-G01 "Personal Financial Statement" - Texas

What Is Form CORP-G01?

This is a legal form that was released by the Texas Department of Banking - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the Texas Department of Banking;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CORP-G01 by clicking the link below or browse more documents and templates provided by the Texas Department of Banking.

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Download Form CORP-G01 "Personal Financial Statement" - Texas

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Texas Department of Banking
Personal Financial Statement
As of: _______________________
IF ASSETS ARE JOINTLY OWNED, BOTH PARTIES MUST SIGN THIS STATEMENT.
(Fill in all blanks, writing “NO” or “NONE” where necessary to complete information requested.)
Provide additional sheets as necessary and sign and date each additional sheet provided.
and
)
-
Name(s):
Business Phone:
:
)
-
Residence Address:
Residence Phone
)
-
City, State, & Zip Code:
Cell Phone:
Business Name of Applicant/Borrower:
ASSETS
LIABILITIES
Cash on hands and in Banks
Accounts Payable
$
$
Savings Accounts
Notes & Leases Payable to Banks and Others
(Describe in Section 2)
IRA or Other Retirement Account
Installment Account (Auto)
Mo. Payments $
Accounts & Notes Receivable
Installment Account (other) Mo. Payments
$
Life Insurance-Cash Surrender Value Only
Loan on Life Insurance
(Complete Section 8)
Stocks and Bonds (Describe in Section 3)
Mortgages on Real Estate (Describe in Section 4)
Real Estate - (Describe in Section 4)
Unpaid Taxes - (Describe in Section 6)
Automobile - Present Value
Other Liabilities - (Describe in Section 7)
Other Personal Property - (Describe in Section 5)
$
Total Liabilities
0.00
Other Assets - (Describe in Section 5)
Net Worth
TOTAL
$
TOTAL
$
0.00
0.00
Section 1.
Source of Income
Contingent Liabilities Describe all including amounts.
Salary
$
As Co-Maker, Endorser, Surety, Bondsman,
$
$
$
Net Investment Income
Have any Legal Claims & Judgments
Real Estate Income
$
Provision for Federal Income Tax
$
(Describe in Section 6)
Other Income (Describe Below)*
$
Other Special Debt including
$
Letters of Credit and Leases
Description of Other Income in Section 1.
Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income
Yes
No
Are any returns being contested?
Are your tax obligations current?
Income tax returns are filed through (date)
Yes
No
(Describe in Section 6)
Have either you or any firm in which you were a major owner ever
Do you have a line of credit or an unused credit facility
If so where?
Yes
No If so, provide details
Yes
No
how much?
declared bankruptcy?
at any other institution?
Section 2.
Notes & Leases Payable to Banks and Others
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Name and Address of Noteholder(s)
Original
Current
Payment
Frequency
How Secured or Endorsed
Balance
Balance
Amount
(Monthly, etc.)
Type of Collateral
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
CORP-G01 (7/14)
Texas Department of Banking
1
Texas Department of Banking
Personal Financial Statement
As of: _______________________
IF ASSETS ARE JOINTLY OWNED, BOTH PARTIES MUST SIGN THIS STATEMENT.
(Fill in all blanks, writing “NO” or “NONE” where necessary to complete information requested.)
Provide additional sheets as necessary and sign and date each additional sheet provided.
and
)
-
Name(s):
Business Phone:
:
)
-
Residence Address:
Residence Phone
)
-
City, State, & Zip Code:
Cell Phone:
Business Name of Applicant/Borrower:
ASSETS
LIABILITIES
Cash on hands and in Banks
Accounts Payable
$
$
Savings Accounts
Notes & Leases Payable to Banks and Others
(Describe in Section 2)
IRA or Other Retirement Account
Installment Account (Auto)
Mo. Payments $
Accounts & Notes Receivable
Installment Account (other) Mo. Payments
$
Life Insurance-Cash Surrender Value Only
Loan on Life Insurance
(Complete Section 8)
Stocks and Bonds (Describe in Section 3)
Mortgages on Real Estate (Describe in Section 4)
Real Estate - (Describe in Section 4)
Unpaid Taxes - (Describe in Section 6)
Automobile - Present Value
Other Liabilities - (Describe in Section 7)
Other Personal Property - (Describe in Section 5)
$
Total Liabilities
0.00
Other Assets - (Describe in Section 5)
Net Worth
TOTAL
$
TOTAL
$
0.00
0.00
Section 1.
Source of Income
Contingent Liabilities Describe all including amounts.
Salary
$
As Co-Maker, Endorser, Surety, Bondsman,
$
$
$
Net Investment Income
Have any Legal Claims & Judgments
Real Estate Income
$
Provision for Federal Income Tax
$
(Describe in Section 6)
Other Income (Describe Below)*
$
Other Special Debt including
$
Letters of Credit and Leases
Description of Other Income in Section 1.
Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income
Yes
No
Are any returns being contested?
Are your tax obligations current?
Income tax returns are filed through (date)
Yes
No
(Describe in Section 6)
Have either you or any firm in which you were a major owner ever
Do you have a line of credit or an unused credit facility
If so where?
Yes
No If so, provide details
Yes
No
how much?
declared bankruptcy?
at any other institution?
Section 2.
Notes & Leases Payable to Banks and Others
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Name and Address of Noteholder(s)
Original
Current
Payment
Frequency
How Secured or Endorsed
Balance
Balance
Amount
(Monthly, etc.)
Type of Collateral
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
CORP-G01 (7/14)
Texas Department of Banking
1
Section 3.
Stocks and Bonds
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Number of
Market Value
Date of
Securities
Name of Securities
Cost
Quotation/Exchange
Quotation/Exchange
Total Value
/
$
$
/
$
$
/
$
$
/
$
$
/
$
$
Section 4.
Real Estate Owned (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Property A
Property B
Property C
Type of Property
Name of Title Holder
Property Address
Date Purchased
Original Cost
$
$
$
Present Market Value
$
$
$
Name & Address of Mortgage
Holder
Mortgage Account Number
Mortgage Balance
$
$
$
Amount of Payment per
mo. /
yr.
mo. /
yr.
mo. /
yr.
$
$
$
$
$
$
Month/Year
Status of Mortgage
Section 5.
Other Personal Property and Other Assets
(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 6.
Unpaid Taxes
(Describe in detail as to type, to whom payable, when due, amount, and to what property, if any, a tax lien is attached.)
Section 7.
Other Liabilities
(Describe in detail).
Section 8.
Life Insurance Held
Face amount and cash surrender value of policies. name of insurance company and beneficiaries.)
Insurance Company:
Beneficiary:
Face Amount: $
Insurance Company:
Beneficiary:
Face Amount: $
I hereby certify under penalty of perjury that the information contained in this confidential financial report,
including supplemental schedules, has been carefully examined by me and is correct and complete, and further
acknowledge that there are no misrepresentations or omissions of material facts.
Signature
Date
Signature
Date
CORP-G01 (7/14)
Texas Department of Banking
2
Clear Form
Texas Department of Banking
Cash Flow Statement
Name: _________________________________________
Provide the following information regarding sources and uses of cash during the last two years, the current year, and a projected year.
Current
Projected
Sources of Cash
20____
20____
_______ to _______
__________
Salaries, Wages,
Commissions, Bonuses, or
Other income from
Employment (Net of
Deduction)
Dividends
Interest
Royalties
Cash Received from
Individual Businesses,
Partnerships, or Joint
Ventures
Real Estate
Other*
Total Cash Received
$ 0
$ 0
$ 0
$ 0
Current
Projected
Uses of Cash
20____
20____
_______ to _______
__________
Personal Expenses
(Management, Rent and
Household, etc.)
Bank Loan – Principal and
Interest
Insurance Payments
Income Taxes Not Covered
by Withholding
Other*
Total Cash Outlays
$ 0
$ 0
$ 0
$ 0
Cash Flow Surplus
$ 0
$ 0
$ 0
(Deficit)
$ 0
*Itemize any items amounting to 10% or more of total income on a separate page.
CORP-G01 (7/14)
Texas Department of Banking
3
I hereby certify under penalty of perjury that the information contained in this confidential financial report,
including supplemental schedules, has been carefully examined by me and is correct and complete, and
further acknowledge that there are no misrepresentations or omissions of material facts.
Signature: ____________________________________________ Date: ______________________________
Full Name: ___________________________________________
STATE OF TEXAS
COUNTY OF __________________
Personally appeared before me the above named,
________________________________________,
personally known to me, who, being duly sworn, deposes and says that he/she executed the above instrument
and that the statements and answers contained therein are true and correct.
Subscribed and sworn to before me this
________
day of ___________________________, ________.
________________________________________
(Notary Public)
(Seal)
My Commission expires: ___________________
CORP-G01 (7/14)
Texas Department of Banking
4