FIS 0514 (08/16) Department of Insurance and Financial Services Page 1 of 2 Debt Management Financial Statement DATED: ____________________ CURRENT ASSETS: Cash Marketable Securities Accounts Receivable [Less Allowance for Doubtful Accounts of ($ Notes Receivable Prepaid Expenses Other Current Assets TOTAL CURRENT ASSETS NON-CURRENT ASSETS: ASSETS $_______________ $_______________ )] $_______________ $_______________ $_______________ $_______________ $_______________ Accounts Receivable Non-Current [Less Allowance for Doubtful Accounts of ($ )] Investment: $_______________ (Current Market Value) $_______________ $_______________ (At Cost) TOTAL NON-CURRENT ASSETS FIXED ASSETS: Property and Equipment at Cost Land Buildings Furniture & Fixtures Equipment Less Allowance for Deprecation Net Property & Equipment $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ TOTAL FIXED ASSETS OTHER ASSETS: (DESCRIBE FULLY IN NOTES TO FINANCIAL STATEMENTS) Trust Account Balance TOTAL OTHER ASSETS TOTAL ASSETS $_______________ $_______________ $_______________ American LegalNet, Inc. www.FormsWorkFlow.com FIS 0514 (08/16) Department of Insurance and Financial Services Page 2 of 2 Debt Management Financial Statement LIABILITIES CURRENT LIABILITIES Accounts Payable Notes Payable Due to Creditors from Trust Account Accrued Expenses Insurance & Taxes Payable Long-Term Debt (Current Portion) Other Current Liabilities TOTAL CURRENT LIABILITIES LONG-TERM LIABILITIES: $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ Long-Term Debt Less Current Portion Net Long-Term Debt Other Long-Term Liabilities TOTAL LONG-TERM LIABILITIES TOTAL LIABILITIES $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ NET WORTH OR EQUITY NOTE: Complete only A or B A) Sole Proprietorship or Partnership complete this portion: Net Worth (Assets Less Liabilities) $_______________ B) Corporation complete this portion: Equity: a) Capital Stock (Par Value) Authorized Issued & Outstanding b) Donated Capital c) Other d) Retained Earnings: (Accumulated Deficit) TOTAL EQUITY TOTAL NET WORTH (FROM A or B) TOTAL LIABILITIES AND NET WORTH OR EQUITY $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ American LegalNet, Inc. www.FormsWorkFlow.com