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: ( )
Name and Address of Business
Sole Proprietor Other
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
Cash on Hand
Bank Accounts: Include Savings & Loans, Credit Unions, Line of Credit, etc.
Name of Institution Address Type of Account Account Number Balance
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