Commercial Debtor Financial Statement Page 2
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4Section I (continued) General Financial Information
12 Real Property
Brief description and type of ownership
Physical Address
a
County …………………..
b
County …………………..
c
County …………………..
d
County …………………..
13 Life insurance policies owned with business as beneficiary
Name Insured
Company
Policy Number
Type
Face Amount
Available Loan Value
►
Total (Enter in item 19) ………………………………………………………………………………………………………………………
14a Additional information regarding financial condition (Court proceedings, bankruptcies filed or anticipated, transfers of assets for less than full value, changes in
market conditions, etc. Include information regarding company participation in trusts, estates, profit-sharing plans, etc.)
b
If you know of any person or
(i) Who borrowed the funds?
organization that borrowed or otherwise
provided funds to pay net payrrolls:
(ii) Who supplied the funds?
15 Account/notes receivable (include current contract jobs, loans to stockholders, officers, partners, etc.)
Name
Address
Amount Due
Date Due
Status
$
$
►
Total (Enter in item 18)………………………………………………
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