Form 433-B(Oic) - Collection Information Statement For Businesses - Internal Revenue Service Page 3
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Section 2
Business Asset Information
(Continued)
If the business owns more properties, vehicles, or equipment than shown in this form, please list on a separate attachment.
Real Estate
(Buildings, Lots, Commercial Property, etc.)
Property Address
Property Description
Date Purchased
(Street Address, City, State, ZIP
Code)
Name of Creditor
Date of Final Payment
County and Country
Current Market Value
Minus Loan Balance
(mortgages, etc.)
$
X .8 = $
– $
Total Value of Real Estate =
(3a) $
Property Address
Property Description
Date Purchased
(Street Address, City, State, ZIP
Code)
Name of Creditor
Date of Final Payment
County and Country
Current Market Value
Minus Loan Balance
(mortgages, etc.)
$
X .8 = $
– $
(3b) $
Total Value of Real Estate =
Total value of property(s) listed from attachment [current market value X .8 minus any loan balance(s)]
(3c) $
Add lines (3a) through (3c) =
(3) $
Business Vehicles
. If additional space is needed, list on an attachment.
(cars, boats, motorcycles, trailers, etc.)
Vehicle Make & Model
Year
Date Purchased
Mileage or Use Hours
Monthly Lease/Loan Amount
Name of Creditor
Date of Final Payment
Lease
Loan
$
Current Market Value
Minus Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
(4a) $
=
is leased, enter 0 as the total value)
Vehicle Make & Model
Year
Date Purchased
Mileage or Use Hours
Monthly Lease/Loan Amount
Name of Creditor
Date of Final Payment
Lease
Loan
$
Current Market Value
Minus Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
(4b) $
=
is leased, enter 0 as the total value)
Vehicle Make & Model
Year
Date Purchased
Mileage or Use Hours
Monthly Lease/Loan Amount
Name of Creditor
Date of Final Payment
Lease
Loan
$
Current Market Value
Minus Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
(4c) $
=
is leased, enter 0 as the total value)
Total value of vehicles listed from attachment [current market value X .8 minus any loan balance(s)]
(4d) $
Add lines (4a) through (4d) =
(4) $
433-B (OIC)
Form
(Rev. 3-2017)
Catalog Number 55897B
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