Form Ro-1062 - Collection Information Statement For Individuals - N. C. Department Of Revenue Page 2
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General Financial Information
Section III – continued
RO–1062
Web
7–94
22. Bank charge cards, Credit Unions, Savings and Loan, Lines of credit
Type of Account
Name and Address of
Monthly
Credit
Credit
Amount
or Card
Payment
Limit
Owed
Available
Financial Institution
Totals (Enter in Item 34)
23. Safe deposit boxes rented or accessed (List all locations, box numbers, and contents)
24.
Real Property (Brief description and type of ownership)
Physical Address
a.
County
b.
County
c.
County
25.
Life Insurance (Name of Company)
Policy Number
Type
Face Amount
Available Loan Value
Total (Enter in Item 30)
26.
Other information relating to your financial condition. If you check the yes box, please give dates and explain under remarks.
No
Yes
Yes
No
a. Court proceedings
b.
Bankruptcies
d.
Recent transfer of assets
Yes
No
Yes
No
c. Repossessions
for less than full value
f.
Participant or beneficiary to trust,
Yes
No
e. Anticipated increase in income
Yes
No
estate, profit sharing, etc.
Remarks
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