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Name Address Home Phone SSN Birthdate Dorian Rothschild 60 Arthur St. San Rafael, CA 94901 415 456-1234 123-45-6789 April 19, 1985
DETAILED LISTING OF ASSETS Checking Accounts: Bank/Financial Institution Redwood Bank Bear Bank
Balance
$10,000.00 $4,300.00
$14,300.00
Balance
$36,450.00 $28,000.00
$64,450.00
Household Goods/Furnishings: Description dining table beige leather furniture set master bed office desk
Value
$2,700.00 $9,400.00 $2,400.00 $550.00
$15,050.00
Value
Spouse You Spouse
$20,500.00
Value
$11,500.00 $16,000.00
$27,500.00
Value
$900.00 $7,600.00
$8,500.00
Stocks and Mutual Funds: Description 100 shares of Polysoft stock 1200 shares Rubicon Law Firm stock
Value
$1,100.00 $9,000.00
$10,100.00
Retirement Plans: Name and Type of Plan Iris Plan 401k Gina Pension Plan
Value
$23,400.00 $18,500.00
$41,900.00
TOTAL ASSETS:
Total Assets
$202,300.00
DETAILED LISTING OF LIABILITIES Mortgages - Personal Residence: Lender Loan No. Ellison Financial Services Inc 1234546
Monthly Payment
$1,980.00
Balance Due
$210,000.00
$210,000.00
Monthly Payment
$450.00 $490.00
Balance Due
$3,200.00 $9,875.00
Monthly Payment
$85.00
Balance Due
$650.00
$650.00
Monthly Payment
$350.00
Balance Due
$27,500.00
$27,500.00
TOTAL LIABILITIES:
$251,225.00 $-48,925.00
============
SUMMARY LISTING OF ASSETS AND LIABILITIES ASSETS Checking Accts Savings Accts Household Goods Jewelry Vehicles Recreational Equip. Stocks/Mutual Funds Retirement Plans Amount
$14,300.00 $64,450.00 $15,050.00 $20,500.00 $27,500.00 $8,500.00 $10,100.00 $41,900.00
LIABILITIES Pers. Residence Vehicle Loan Credit Card Debt Student Loans
Amount
$210,000.00 $13,075.00 $650.00 $27,500.00
============
SOURCES OF MONTHLY INCOME: Salaries and Wages: Employer RL Electronics Brookside Elementary School Dorian Rothschild's Total Monthly Wages Investment Accounts Trusts Other Sources TOTAL MONTHLY INCOME MONTHLY EXPENSES: Child Care Food Health Care/Medication Utilities Housing/Rent Other Mortgage Loans Auto Loans Auto Insurance Other Insurance Credit Cards Student Loans Other Expenses (including clothing, recreation, misc.) TOTAL MONTHLY EXPENSES
Annual Wages
$93,600.00 $45,000.00
Monthly Wages
$7,800.00 $3,750.00 $7,800.00 $0.00 $0.00 $0.00
_____________
$11,550.00
$0.00 $1,200.00 $600.00 $420.00 $1,980.00 $0.00 $940.00 $845.00 $0.00 $85.00 $350.00 $0.00
_____________
$6,420.00
I certify and warrant that to the best of my knowledge the information contained in this Personal Financial Statement is true, correct and complete.
__________________________________________ Date