Form 433-B (Oic) - Collection Information Statement For Businesses 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 an attachment.
Real Estate
(Buildings, Lots, Commercial Property, etc.)
Do not use negative numbers.
Property Address
Date Purchased
(Street Address, City, State, ZIP Code)
Property Description
County and Country
Current Market Value
Less Loan Balance
(Mortgages, etc.)
$
X .8 = $
– $
Total Value of Real Estate = (3a) $
Property Address
(Street Address, City, State, ZIP Code)
Property Description
Date Purchased
County and Country
Current Market Value
Less Loan Balance
(Mortgages, etc.)
$
X .8 = $
– $
Total Value of Real Estate = (3b) $
Total value of property(s) listed from attachment [current market value X .8 less 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
Lease
$
Loan
Current Market Value
Less Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
is leased, enter 0 as the total value) =
(4a) $
Vehicle Make & Model
Year
Date Purchased
Mileage or Use Hours
Monthly Lease/Loan Amount
Lease
$
Loan
Current Market Value
Less Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
is leased, enter 0 as the total value) =
(4b) $
Vehicle Make & Model
Year
Date Purchased
Mileage or Use Hours
Monthly Lease/Loan Amount
Lease
$
Loan
Current Market Value
Less Loan Balance
Total value of vehicle
(if the vehicle
$
X .8 = $
– $
is leased, enter 0 as the total value) =
(4c) $
Total value of vehicles listed from attachment [current market value X .8 less any loan balance(s)]
(4d) $
Add lines (4a) through (4d) =
(4)
$
Other Business Equipment
Current Market Value
Less Loan Balance
Total value of equipment
$
X .8 = $
– $
=
(if leased, enter 0 as the total value)
(5a) $
(5b) $
Total value of equipment listed from attachment [current market value X .8 less any loan balance(s)]
IRS allowed exemption for professional books and tools of trade - (5c) $ [4,290]
Total value of all business equipment =
(5)
$
Add lines (5a) and (5b) minus line (5c), if number is less than zero, enter zero =
Box 1 Available Equity in Assets
Do not include the amount on lines with a letter beside the number.
$
Add lines (1) through (5) and enter the amount in Box 1 =
433-B (OIC)
Catalog Number 55897B
Form
(Rev. 5-2012)
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