Form 433b - Collection Information Statement For Businesses Page 3

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Section II.
Asset and Liability Analysis
Description
Cur. Mkt
.
Liabilities
E
quity in
Amt.
of Mo.
Na
me
and Address of
Date Pledged
Date of
(a)
Value
Bal. Due
Asset
P
ymt
Lien
/
Note Holder /
(g)
Fin
al Pymt
(b)
(c)
(d)
(e)
O
bli
gee
(h)
(
f)
16. Cash on hand
0.00
17. Bank Accounts
18. Accounts /Note
0.00
Receivable
19. Life insurance loan value
0.00
a.
20. Real
b.
property
(from Item
c.
12)
d.
a.
21.
Vehicles
b.
(Model, year
and license)
c.
22.
a.
Machinery
and
b.
equipment
(Specify)
c.
23.
a.
Merchan-
dise
b.
inventory
(Specify)
24. Other
a.
assets
(Specify)
b.
a.
b.
c.
25. Other
liabilities
d.
(Including
notes and
e.
judgments)
f.
g.
26. State taxes owed
27. Total
0.00
0.00

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