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  1.  
  2.                               [NET WORTH FORM]
  3.  
  4. Year __________________________
  5.  
  6. ===========================================================================
  7.  
  8. Assets
  9. Cash on hand              $______________  $______________  $______________
  10. Bank accounts (checking
  11.    and savings)            ______________   ______________   ______________
  12. Credit union account       ______________   ______________   ______________
  13. Savings & loan accounts    ______________   ______________   ______________
  14. Other savings accounts     ______________   ______________   ______________
  15. House, market value        ______________   ______________   ______________
  16. Other real estate          ______________   ______________   ______________
  17. Household furnishings      ______________   ______________   ______________
  18. Automobiles (blue book
  19.    value)                  ______________   ______________   ______________
  20. Life insurance, cash value ______________   ______________   ______________
  21. Stocks and bonds, current
  22.    value                   ______________   ______________   ______________
  23. Profit-sharing or
  24.    retirement plans        ______________   ______________   ______________
  25. U.S. Savings Bonds         ______________   ______________   ______________
  26. Money owed you             ______________   ______________   ______________
  27. Other assets/investments   ______________   ______________   ______________
  28. Personal property          ______________   ______________   ______________
  29. TOTAL ASSETS               ______________   ______________   ______________
  30.  
  31. Obligations
  32. Mortgages, balance due    $______________  $______________  $______________
  33. Other loans
  34.    (bank, credit union)    ______________   ______________   ______________
  35. Installment debts, balance
  36.    due                     ______________   ______________   ______________
  37. Credit cards, balance due  ______________   ______________   ______________
  38. Charge accounts, owed      ______________   ______________   ______________
  39. Other debts                ______________   ______________   ______________
  40. Insurance premiums due     ______________   ______________   ______________
  41. Taxes owed                 ______________   ______________   ______________
  42. Other current bills        ______________   ______________   ______________
  43. TOTAL DEBTS                ______________   ______________   ______________
  44.  
  45. NET WORTH
  46. (assets minus debts)      $______________  $______________  $______________
  47.