Form 4180 - Report Of Interview With Individual Relative To Trust Fund Recovery Penalty Or Personal Liability For Excise Taxes Page 2

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Section II. —
Business Entity Background Information
continued
6. Is the business still operating?
Was any property of the business sold, transferred, quit-claimed,
7.
donated, or otherwise disposed of, for less than full value?
Yes
No
Yes
(Provide explanation.)
No
When did it stop operating?
What happened to the assets?
8.
Which banks or financial institutions did the business use for transactions such as checking, savings, loans, financing agreements, etc.?
Name
Address
Types of Transactions
Dates
9.
Please provide the names and dates of service for the positions indicated below.
(Continue in Section VI, if necessary.)
Position
Name
Address
Dates
Chairman of the Board
Other Directors
(List)
President
Vice President
Treasurer
Secretary
Other shareholders,
members, owners
10.
Other than those previously listed, please provide the name, address, and telephone number of anyone else who may have additional
knowledge about or control over the company's financial affairs.
Name
Telephone Number
Address
(
)
(
)
(
)
4180
Form
(Rev. 9-2004)
Page 2 of 5
Department of the Treasury – Internal Revenue Service
Catalog No. 22710P

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