Business Financial Statement Form 3 - Free Download
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DE 926C Rev. 12 (7-03) (INTERNET) Page 1 of 4 CU
FINANCIAL STATEMENT FOR BUSINESSES
Employment Development Department
NOTE: Complete all blocks except “Dept. Use Only” blocks. Write “N/A” (not applicable) in those blocks that do not apply.
Employer Acct. No.:
Bus. Phone: ( )
Federal I.D.#:
Name and Address of Business
Sole Proprietor Other
Partnership
Corporation – State of Inc.:
Date of Inc.:
CA Corp. I.D.#:
Name, title and telephone number of person completing Financial Statement Type of Business
List Owner, Partners, Officers, Major Shareholder, etc.
Name and Title
Effective
Date
Home Address
Phone
Number
Social Security
Number
Driver
License #
Current Assets
Cash on Hand
$
Bank Accounts: Include Savings & Loans, Credit Unions, Line of Credit, etc.
Name of Institution Address Type of Account Account Number Balance
$
Accounts/Notes Receivable
Name Address Amount
$
Securities: Stocks, Bonds, Mutual Funds, Money Market Funds, Government Securities, etc.
Kind Quantity or Denomination Where Located Value
$
Dept. Use Only Section A
