Form Ro-1063 - Collection Information Statement For Businesses Page 2
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1
2
3
4Section I
- continued
General Financial Information
12. Real property
Brief Description and Type of Ownership
Physical Address
a.
County
County
b.
c.
County
d.
County
13. Life insurance policies owned with business as beneficiary
Policy
Face
Available Loan
Number
Type
Amount
Value
Company
Name Insured
Total
( Enter in Item 19)
14. 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.
15. Accounts/Notes receivable (include current contract jobs, loans to stockholders, officers, partners, etc.)
Name
Address
Amount Due
Date Due
Status
$
$
Total
( Enter in Item 18)
Page 2
Form RO - 1063 (4-90)
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