Form Rev-484 - Statement Of Financial Condition For Businesses Page 2
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3SECTION I – GENERAL FINANCIAL INFORMATION (continued)
12. Real Property
Include county and state.
Brief Description and Type of Ownership
Address
a.
b.
c.
d.
13. Life insurance policies owned with business as beneficiary
Available Loan
Face Value
Name Insured
Company
Policy Number
Type
Value
$
$
TOTAL
Enter in Item 19.
$
(Court proceedings, bankruptcies filed or anticipated, transfers of assets for less than
14. Additional information regarding financial condition
full value, changes in market conditions, etc.; include information regarding company participation in trust, estates, retirement plans, etc.)
Include loans to stockholders, officers, partners, etc.
15. Accounts/notes receivable
Name
Address
Amount Due
Date Due
Status
MM/DD/YYYY
$
TOTAL
$
Enter in Item 18.
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Parent category: Financial