Business Type Information

Individual Partnership Corporation Limited Liability Company Limited Liability Partnership

 

Applicant Information
Applicant:
Social Security#	Age	Marital Status
		Married Single
Residence Address	City	State	Zip
Business Address	City	State	Zip
Email Address	Home Phone	Work Phone
Occupation or Business			How long?
Previous Surety?
Yes No   If yes, give name and reason for change:
Type of Bond	Amount of Bond	Effective Date
	$
Complete name and address of Obligee

 

FINANCIAL STATEMENT as of

Select one: Business Financial Statement Personal Financial Statement

Financial Information
ASSETS		LIABILITIES
Cash ( List Banks below )	$	Accounts Payable	$
		Taxes due & accrued	$
Stocks & Bonds (Describe below)	$	Notes Payable to Bank	$
		Notes Payable to Others	$
Notes Receivable	$	Mortgage on Real Estate A	$
Merchandise or Material in Stock	$	Mortgage on Real Estate B	$
Accounts Receivable	$	Other Liabilities (Describe below)	$
Real Estate, Homestead A	$
Real Estate, Investment B	$	TOTAL LIABILITIES Capital Stock (Paid in)	$
Furniture and Fixtures	$		$
Other Assets	$	NET WORTH OR SURPLUS	$
TOTAL ASSETS	$	TOTAL Liabilities / Net Worth	$

 

Sales / Income
GROSS SALES		NET INCOME
Two Years Ago	$	Two Years Ago	$
Last Year	$	Last Year	$

Probate Bond Information
Name of deceased (Ward)		Date of death
Date of Appointment	(If over 6 months, please explain delay.)
(mm/dd/yy)
Is applicant indebted to the estate or trust?If yes, please explain.
Yes No
Name and address of attorney (If none, do not write the bond; submit to our underwriters)
Will the attorney remain involved throughout the duration of this estate?
Yes No
Assets of estate or trust (describe)
Name, age, and health status of
Minor(s) Incompetent
Applicant's relationship to		Applicant's Net Worth
deceased ward(s)		$
Are guardianship funds to be used for support of ward?   (If Yes, approximately how much per month?)
Yes No                                                     $
What is the source of the guardianship funds? (If an insurance settlement, do not execute the bond; instead refer it to an underwriter.)
Who are the heirs of this estate?
Has anyone objected to the applicant's appointment as fiduciary?
Yes No
Will any going business (excluding farms) of the estate be continued by fiduciary? (If yes, send a copy of court order.)
Yes No
Is this bond required on the demand of an interested person?       If Yes, who?
Yes No
Name and address of court:
What is the applicant's experience in handling fiduciary responsibilities?

 

Additional Comments

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