Form Cm-2b - Statement Of Financial Condition And Other Information

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Department of Taxation - State of Hawaii
Hawaii
STATEMENT OF FINANCIAL CONDITION AND OTHER INFORMATION
Form CM - 2B
(Rev. Oct 95)
Section I.
General Information - For Corporations, Partnerships, etc.
(
)
1. Name and address of business
2. Business phone no.
3. Please check appropriate item:
( ) Corporation
( ) Partnership
( ) Other (specify) _____________________
4. Name and title of person being interviewed
5. Federal I.D. No.
6. General Excise I.D. No.
7. Information about owner, partners, officers, major shareholder, etc.
Effective
Home Phone
Social Security
Name, Title, % ownership, # of shares
Date
Home Address
Number
Number
Section II.
General Financial Information
8. Bank account (include Savings & Loans, Credit Unions, IRA and Retirment Plans, Certificate of Deposits, etc.) Attach additional
sheets as necessary.
Name of Institution
Address
Type of Account
Account No.
Balance
Total (Enter in Item 17)
9. Charge cards, bank credit available (Lines of credit, etc.) Attach additional sheets as necessary.
Type of Account
Name and address of Financial Institution
Monthly
Credit
Amount
Credit
or Card
Payment
Limit
Owed
Available
Total (Enter in Item 27)
10. Safe deposit boxes rented or accessed (List all locations, box numbers, and contents.)
Form CM-2B
Page1

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