Free Financial Statement - Wisconsin

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FINANCIAL STATEMENT
MV2195 11/2000 s.345.17 or s.946.32 Wis. Stats.
Legal Name

Financial Statement Date

Wisconsin Department of Transportation

The figures in this financial statement show assets and liabilities as of the specific date shown above, which MUST be within the past 90 days.
Area Code - Telephone Number License Numbers of ALL Dealerships

Business Address

Post Office Box Number

City

State

Zip Code

Business Entity

Name and Title of Owner, Partners, Association Members, Corporation Officers and Shareholders, LLC Managers and Members

Sole Proprietorship Partnership Association LIABILITIES

Corporation LLC

ASSETS Amount $ 1. Cash on Hand - Not cash in bank 2. Cash in ___________________ Show name 3. Cash in ___________________ of bank 4. Securities Owned - Complete Schedule A 5. Contracts in Transit - No. _____________ Receivables 6. Time contracts dealer holds on MVs or RVs 7. Time contracts dealer holds on merchandise 8. Open Accounts less than 90 days 9. Open Accounts past due 10. Others - Describe Inventories- At lower of cost or book 11. No. _____ New cars, cycles, RVs or Mopeds 12. No. _____ New trucks 13. No. _____ Implements 14. No. _____ Demonstrators 15. No. _____ Used vehicles 16. New Parts 17. Accessories 18. Gas, oil, grease 19. Other Inventory - Describe 20. ___________________________________ 21. ___________________________________ Prepaid Expenses 22. Taxes and Interest 23. Rent and Insurance 24. Other Prepaid Expenses 25. Total Lines 1-24 inclusive $ 0.00 Fixed Assets- Complete Schedule B 26. Land and Buildings - Dealer Business 27. Land and Buildings - Other 28. Leasehold Improvements 29. Machinery, Tools and Equipment 30. Office Furniture and Fixtures 31. Leased Vehicles Deferred Assets 32. Deposits on contracts 33. Factory reserve or bonus 34. Finance reserve including holdbacks 35. Officers notes and accounts (corporation) 36. Advances to employes 37. Others _____________________________ Other Assets Not Listed Above 38. ___________________________________ 39. ___________________________________ 40. ___________________________________ 41. ___________________________________ 42. Total Assets (Lines 25-41 inclusive) $ 0.00 43. 44. 45. 46.

Amount $ Accounts Payable Notes Payable - Bank, Schedule C Notes Payable - Other, Schedule C Customer deposits on motor vehicles to be delivered, Attach itemized list 47. Dividends Declared - Not Paid 48. Accrued Payroll 49. Accrued Taxes or Rent 50. Social Security, U.C., Withholding 51. Sales Tax Owed 52. No. _____ New cars, cycles, RVs or Mopeds, Floor-Planned * 53. No. _____ New trucks, Floor-Planned * 54. No. _____ Implements, Floor-Planned * 55. No. _____ Demonstrators, Floor-Planned * 56. No. _____ Used vehicles, Floor-Planned * * List in Schedule D 57. Other Liabilities, including contingent liabilities 58. Total Lines 43-57 inclusive $ Mortgages Payable On: Schedule B 59. Land and Buildings - Dealer Business 60. Land and Buildings - Other 61. Machinery, Tools and Equipment 62. Office Furniture and Fixtures 63. Leased Vehicles 64. Other ______________________________ 65. Judgments Outstanding Depreciation/Amoritzation Reserve, Sch. B 66. Land and Buildings - Dealer Business 67. Land and Buildings - Other 68. Amortization of Leaseholds 69. Machinery, Tools and Equipment 70. Office Furniture and Fixtures 71. Leased Vehicles 72. Other ______________________________ 73. Total Liabilities & Reserves Lines 58-72 incl. $ Net Worth 74. Capital Stock 75. Treasury Stock - if any 76. Partners' Investments - partnership 77. LLC Members' Contributions 78. Surplus beginning of year $ 79. Profit this year 0.00 80. Total Lines 78-79 incl. 81. Less Div./Dist. Declared 82. Total Surplus 83. Net Worth 84. Total Lines 73+83 (Equals Total Assets) $

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0.00

0.00

0.00 0.00 0.00

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SCHEDULE A - SECURITIES OWNED - Line 4 of Financial Statement NO. OF SHARES OR FACE AMOUNT ISSUER OF STOCKS OR BONDS REGISTERED IN NAME OF

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BOOK VALUE MARKET VALUE

None of the above items are pledged as security except items _________________________________________ in the amount of $ SCHEDULE B - FIXED ASSETS AND RESERVES - Lines 26-31 and 58-71 of Financial Statement PROPERTY LOCATION A Real Estate Dealer Business B Real Estate Other C Leasehold Improvements D Machinery, Tools and Equipment E Office Furniture and Fixtures F Leased Vehicles G Other TITLE IN NAME OF (Specify if Joint) ASSESSED VALUE COST OR MARKET VALUE $

TOTAL

$ 0.00

INDEBTEDNESS AMOUNT TO WHOM

SCHEDULE C - NOTES PAYABLE TO BANKS AND OTHERS - Lines 44 and 45 of Financial Statement PAYABLE TO A B C D TOTAL SCHEDULE D - FLOOR-PLAN LIABILITY PAYABLE - Lines 52 - 56 of Financial Statement FINANCE COMPANY NAME AND ADDRESS A B C Note: If floor-plan liability or the number of units floor-planned under items 52-56 inclusive, exceeds the inventory value or the number of units listed under items 11-15 inclusive, please furnish us with an explanation. TOTAL $ 0.00 NUMBER OF UNITS AMOUNT $ 0.00 SECURITY, IF ANY DATE DUE AMOUNT

I, the undersigned, certify under penalty of s.946.32 or 345.17 Wis. Stats., that this financial statement and supporting schedules submitted on behalf of the named applicant are true to the best of my knowledge.
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(Authorized Dealership Agent, Title) (Date)