Form 433-F - Collection Information Statement
Download a blank fillable Form 433-F - Collection Information Statement in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 433-F - Collection Information Statement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Collection Information Statement
Name(s) and Address
Your Social Security Number or Individual Taxpayer Identification Number
Your Spouse’s Social Security Number or Individual Taxpayer Identification Number
If address provided above is different than last return filed,
Your Telephone Numbers
Spouse’s Telephone Numbers
please check here
Home:
Home:
County of Residence
Work:
Work:
Cell:
Cell:
Enter the number of people in the household who can be claimed on this year’s tax return including you and your spouse. Under 65
65 and Over
If you or your spouse are self employed or have self employment income, provide the following information:
Type of Business
Name of Business
Business EIN
Number of Employees
(not counting owner)
A. ACCOUNTS / LINES OF CREDIT Include checking, online, mobile (e.g., PayPal) and savings accounts, Certificates of Deposit,
Trusts, Individual Retirement Accounts (IRAs), Keogh Plans, Simplified Employee Pensions, 401(k) Plans, Profit Sharing Plans,
Mutual Funds, Stocks, Bonds and other investments. If applicable, include business accounts.
(Use additional sheets if necessary.)
Type of
Current
Check if
Name and Address of Institution
Account Number
Account
Balance/Value
Business Account
B. REAL ESTATE Include home, vacation property, timeshares, vacant land and other real estate.
(Use additional sheets if necessary.)
Description/Location/County
Monthly Payment(s)
Financing
Current Value
Balance Owed
Equity
Year Purchased
Purchase Price
Year Refinanced
Refinance Amount
Primary Residence
Other
Year Purchased
Purchase Price
Year Refinanced
Refinance Amount
Other
Primary Residence
C. OTHER ASSETS Include cars, boats, recreational vehicles, whole life policies, etc. Include make, model and year of vehicles
and name of Life Insurance company in Description. If applicable, include business assets such as tools, equipment, inventory, etc.
(Use additional sheets if necessary.)
Description
Monthly Payment Year Purchased Final Payment
Current Value
Balance Owed
Equity
(mo/yr)
/
/
/
/
/
/
/
NOTES
(For IRS Use Only)
TURN PAGE TO CONTINUE
Form 433-F (Rev. 1-2013) Catalog 62053J Department of the Treasury Internal Revenue Service publish.no.irs.gov
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial