Form Ador 20-1020 - Collection Information Statement For Business Page 2
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2
3
4Section I. (continued)
General Financial Information
12. Real property
Brief Description and Type of Ownership
Address (include County and State)
a.
b.
c.
d.
13. Life insurance policies owned with business as beneficiary
Available Loan
Name Insured
Company
Policy Number
Type
Face Amount
Value
Totals (Enter on line 19)
$
14. Other information relating to the business' financial condition. If you check the yes box, please give dates and explain in Section III.
Yes
No
Yes
No
a. Court Proceedings
b. Bankruptcies
d. Recent transfer of assets for less
Yes
No
Yes
No
c. Repossessions
f. Participant or beneficiary to trust
Yes
No
Yes
No
e. Anticipated increase in income
estate, profit sharing, etc.
15. Accounts/Notes receivable (Include loans to stockholders, officers, partners, etc.)
Name of Institution
Address
Amount Due
Date Due
Status
$
$
Total (Enter on line 18)
ADOR 20-1020 (10/01)
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