Form Ro-1063 - Collection Information Statement For Business Page 5
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6Business Financial Statement- (Rev. 12/09)
Page 5
22. Vehicles Leased and Purchased. Include boats, RVs, motorcycles, trailers, mobile homes, etc.
22a. Description
Purchase/Lease Date
Current Fair Market
Current Loan
Amount of Monthly
Date of Final
Equity
(Make, Model,
(mm/dd/yy)
Value (FMV)
Balance
Payment
Payment
FMV minus loan
Year, Mileage)
Lender/Lessor Name, Address, (Street, Address, State, ZIP code)
Make
Model
Year
Mileage
22b. Description
Purchase/Lease Date
Current Fair Market
Current Loan
Amount of Monthly
Date of Final
Equity
(Make, Model,
(mm/dd/yy)
Value (FMV)
Balance
Payment
Payment
FMV minus loan
Year, Mileage)
Lender/Lessor Name, Address, (Street, Address, State, ZIP code)
Make
Model
Year
Mileage
22c. Description
Purchase/Lease Date
Current Fair Market
Current Loan
Amount of Monthly
Date of Final
Equity
(Make, Model,
(mm/dd/yy)
Value (FMV)
Balance
Payment
Payment
FMV minus loan
Year, Mileage)
Lender/Lessor Name, Address, (Street, Address, State, ZIP code)
Make
Model
Year
Mileage
22d. Description
Purchase/Lease Date
Current Fair Market
Current Loan
Amount of Monthly
Date of Final
Equity
(Make, Model,
(mm/dd/yy)
Value (FMV)
Balance
Payment
Payment
FMV minus loan
Year, Mileage)
Lender/Lessor Name, Address, (Street, Address, State, ZIP code)
Make
Model
Year
Mileage
22e. Total Fair Market Value
22f. Total Current Loan Balance
22g. Net Equity
Business Equipment. Include all machinery, equipment, merchandise inventory, and/or other assets.
Include Uniform Commercial Code (UCC) filings.
Current Fair
Amount of
Date of Final
Equity
Purchase/Lease Date
Market Value
Current Loan
Monthly
Payment
FMV
(mm/dd/yyyy)
(FMV)
Balance
Payment
(mm/dd/yyyy)
Minus Loan
23a. Asset Description
$
$
$
Lender/Lesser/Landlord Name, Address
and Phone
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code) and County
23b. Asset Description
$
$
$
Lender/Lesser/Landlord Name, Address
and Phone
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code) and County
23c. Asset Description
$
$
$
Lender/Lesser/Landlord Name, Address
and Phone
Location (Street, City, State, ZIP code) and County
(Street, City, State, ZIP code)
23d. Asset Description
$
$
$
Lender/Lesser/Landlord Name, Address
and Phone
(Street, City, State, ZIP code)
Location (Street, City, State, ZIP code) and County
23e. Total Fair Market Value
23f. Total Current Loan Balance
23g. Net Equity
Business Financial Statement- Page 5
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