Form Tp-229 - Financial Statement Of Distributors Of Alcoholic Beverages Page 2
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1
2Page 2 of 2 TP-229 (12/14)
Land and Buildings
Title in
Estimated
Assessed
Mortgage
Payments on
Rate
Annual
Description and location
Mortgaged for
Insured for
name of
value
value
held by
mortgage
(%)
rental
Notes Payable to Others
Date of note
Due date
Name and address of payee
Face value
Description
Other assets:
Other current
liabilities:
Other fixed
liabilities:
Are you an endorser of any note of an individual, firm or corporation?
Yes
No
If Yes, give amount of note(s) $
(1)
(1)
Bank references: Name
Address
(2)
(2)
(3)
(3)
Signature of applicant
Sworn to
day of
20
Signature of attesting officer
Title of attesting officer
State whether owner or member of firm, or officer of corporation
Investigated by (examiner)
Date
Attach additional sheets if necessary.
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