Offer In Compromise Business Request For Settlement - State Of Virginia Page 2
ADVERTISEMENT
1
2
3
4FINANCIAL INFORMATION STATEMENT FOR BUSINESSES
SECTION I
BUSINESS NAME AND ADDRESS
(complete all blocks)
1. Business Name(s) and Address:
2. Business Account Number:
3. Federal ID Number:
4. Business Phone Number:
5a) Other Contact Phone Number:
(__________)
(__________) _____________________
_____________________________
5b) Other Contact Name:
____________________
6. Business Organization:
________ Sole Proprietor
_________ Partnership
_________ Corporation
______ Other: ________
7. Description of Business:
SECTION II
OFFICERS, OWNERS, SHAREHOLDERS, PARTNERS
8. PERTINENT INFORMATION ON OFFICERS, OWNERS, SHAREHOLDERS, PARTNERS, ETC
Name and Title
Home Address
Telephone Number
Social Security
Total Share
Number
of Interest
SECTION III
BANKING, CREDIT AND PROPERTY INFORMATION
9. BANKING INFORMATION TO INCLUDE CHECKING, SAVINGS, MONEY MARKET, PAYROLL, ETC
Name and Address of Institution
Type of Account
Name Account Listed In
Account Number
Balance
10. CURRENT AVAILABLE CREDIT TO INCLUDE LOANS, CREDIT CARDS, ETC
Name and Address of Institution
Type of Credit
Available Credit
Name Account Listed
Has resource been
contacted?
YES
NO
YES
NO
YES
NO
11. PROPERTY TO INCLUDE REAL ESTATE, NON-NECESSITIES, ETC.
Type of Property
Ownership Listed As
Value
Location of Property
Used as collateral for
previous loans?
YES
NO
YES
NO
(Attach additional information, if necessary)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial