Form Boe-490-C - Offer In Compromise Application Page 9

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Corporate Application

BOE-490-C REV. 1 (11-08)

SeCtION 5. GeNerAL fINANCIAL INfOrmAtION (Continued)

Please provide additional information relating to the financial conditionof the corporation, LLC, pertnership, or trust. If yes is

checked, please provide dates, explanation,and documentation. Documentation should cover the last three years.

DIVIDEND DISTRIBUTIONS (If yes, please list dates and amounts of 3 most recent distributions.)

Yes

PENDING LITIGATION OR JUDGMENTS (If yes, please provide case number and court location.)

Yes

REPOSSESSIONS

Yes

ANTICIPATED INCREASE IN INCOME

Yes

BANKRUPTCIES/RECEIVERSHIPS (If yes, please include chapter, case number, and date filed.)

Yes

RECENT TRANSFER OF ASSETS (If yes, please include details on disbursements of entity’s assets.)

Yes

BUSINESS SOLD (If yes, please provide a copy of the sales contract.)

Yes

ENTITY OFFICIALLY DISSOLVED (If yes, please include details on disbursements of entity’s assets. List all disbursements during the last 6 months on a separate page.)

Yes

BENEFICIARY TO TRUST, ESTATE, ETC.

Yes

ARE FORECLOSURE PROCEEDINGS PENDING ON ANY REAL ESTATE THAT THE ENTITY OWNS OR HAS AN INTEREST IN? (If yes, please give the location of the real estate.)

Yes

SeCtION 6. ASSet ANd LIABILItY ANALYSIS

Current assets

1. Cash

2. Bank accounts/balance (from Section 5)

3. Vehicles/available equity (from Section 5)

4. Loan (from Section 5)

5. Securities (from Section 5)

tOtAL CurreNt ASSetS >>

real property (from Section 5)

ADDRESS OR LOCATION

CURRENT MARKET VALUE