
                              [NET WORTH FORM]

Year __________________________

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Assets
Cash on hand              $______________  $______________  $______________
Bank accounts (checking
   and savings)            ______________   ______________   ______________
Credit union account       ______________   ______________   ______________
Savings & loan accounts    ______________   ______________   ______________
Other savings accounts     ______________   ______________   ______________
House, market value        ______________   ______________   ______________
Other real estate          ______________   ______________   ______________
Household furnishings      ______________   ______________   ______________
Automobiles (blue book
   value)                  ______________   ______________   ______________
Life insurance, cash value ______________   ______________   ______________
Stocks and bonds, current
   value                   ______________   ______________   ______________
Profit-sharing or
   retirement plans        ______________   ______________   ______________
U.S. Savings Bonds         ______________   ______________   ______________
Money owed you             ______________   ______________   ______________
Other assets/investments   ______________   ______________   ______________
Personal property          ______________   ______________   ______________
TOTAL ASSETS               ______________   ______________   ______________

Obligations
Mortgages, balance due    $______________  $______________  $______________
Other loans
   (bank, credit union)    ______________   ______________   ______________
Installment debts, balance
   due                     ______________   ______________   ______________
Credit cards, balance due  ______________   ______________   ______________
Charge accounts, owed      ______________   ______________   ______________
Other debts                ______________   ______________   ______________
Insurance premiums due     ______________   ______________   ______________
Taxes owed                 ______________   ______________   ______________
Other current bills        ______________   ______________   ______________
TOTAL DEBTS                ______________   ______________   ______________

NET WORTH
(assets minus debts)      $______________  $______________  $______________

