Balance Sheet

Attach annual report, audited financial report or report prepared for other regulatory agencies

Finacial Statement: (Required by the Michigan Department of Consumer & Industry Services)

Please provide a copy of your most current balance sheet or have your bookeeper complete and sign form below.

Information stated below is confidential and will be viewed only by the fund administrator and Bureau.

STATEMENT OF ASSETS & LIABILITIES

Assets:

Current Assets(Required)
Cash On Hand in Banks
Stocks & Bonds
Notes & Accounts Receivable
Inventories
Other Current Assets
Total Current Assets
 
Current Assets(Required)
Other Assets
Properties, Building & Equipment
Good Will
Other
Total Assets
 
Liabilities(Required)
Current Liabilities
Accrued Payroll
Trade Accounts Payable
Taxes Payable
Total Current Liabilities
 
Other Liabilities(Required)
Notes Payable, long-term
Mortgages Payable
Total Other Liabilities
Total Liabilities
 
Other Liabilities(Required)
Capital Stock
Paid in Surplus
Retained Earnings
Total Capital
Total Capital & Liabilities
 
Address(Required)