PERSONAL BALANCE SHEET

PEDRO A. PEREZ AND CARMEN A. GONZALEZ DE PEREZ

AS OF _____________ (colocar fecha)

Current Assets
Cash and Checking- Local Currency
Cash and Checking - US Banks
Total Current Assets
Investments
Fixed Income
Equities

$7.594,00
$4.700,00
$12.294,00

Total Investments

$0,00
$0,00
$0,00

Total Real Estate

$60.200,00
$60.200,00

Personal Assets
Jewelry, Antiques
Paints
Auto
Furnishings
Electronics Computers & Appliances
Electronics,
Total Personal Assets

$1.100,00
$1.300,00
$30.100,00
$12.000,00
$2 400 00
$2.400,00
$46.900,00

Real Estate
Home

Current Liabilities
Consumer Loans
Credit Card Balances
Other Liabilities

$6.024,00
$1.488,00
$65,00

Long term Liabilities

Home Mortgage

$18.072,29

Total Liabilities

$25.649,29

Other Assets
Total Other Assets

$0,00

Total Assets $119.394,00

Net worth

$93.744,71

I hereby certify to the best of my knowledge and information that these are complete and true
statements of my assets, liabilities and net worth, including those of my spouse. I further
undertake to produce all supporting documents for each of the entries herein made when
required.
Declarants Signature: _____________________________________________ Date __________