Form Ro-1063 - Collection Information Statement For Business Page 4
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6Business Financial Statement- (Rev. 12/09)
Page 4
21. Real property owned, rented, and leased. Include all real property and land contracts.
21a. Primary Residence
Current Fair
Amount of
Date of Final
Equity
Purchase/Lease Date
County
Market Value
Current Loan
Monthly
Payment
FMV
(mm/dd/yyyy)
Tax Value
(FMV)
Balance
Payment
(mm/dd/yyyy)
Minus Loan
$
$
$
$
Lender/Lesser/Landlord Name, Address
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code)
Property County
Landlord/Lessor Phone Number
First Mortgage Holder
Second Mortgage Home Equity Line
21b. Property Description
Should be able to enter alpha and numeric characters on the line provided for the property description field.
Current Fair
Amount of
Date of Final
Equity
Purchase/Lease Date
County
Market Value
Current Loan
Monthly
Payment
FMV
(mm/dd/yyyy)
Tax Value
(FMV)
Balance
Payment
(mm/dd/yyyy)
Minus Loan
$
$
$
$
Lender/Lesser/Landlord Name, Address
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code)
Property County
Landlord/Lessor Phone Number
21c. Property Description
Current Fair
Amount of
Date of Final
Equity
Purchase/Lease Date
County
Market Value
Current Loan
Monthly
Payment
FMV
(mm/dd/yyyy)
Tax Value
(FMV)
Balance
Payment
(mm/dd/yyyy)
Minus Loan
$
$
$
$
Lender/Lesser/Landlord Name, Address
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code)
Property County
Landlord/Lessor Phone Number
21d. Property Description
Current Fair
Amount of
Date of Final
Equity
Purchase/Lease Date
County
Market Value
Current Loan
Monthly
Payment
FMV
(mm/dd/yyyy)
Tax Value
(FMV)
Balance
Payment
(mm/dd/yyyy)
Minus Loan
$
$
$
$
Lender/Lesser/Landlord Name, Address
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code)
Property County
Landlord/Lessor Phone Number
21e. Total Fair Market Value
21f. Total Current Loan Balance
21g. Net Equity
Attach additional sheets as needed
Business Financial Statement- Page 4
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