Vt Schedule Oic-672 - Collection Information Statement For Businesses Page 3
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1
2
3
4
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6Entity name
*176721300*
Federal ID Number
* 1 7 6 7 2 1 3 0 0 *
SECTION 2
BUSINESS ASSET INFORMATION (cont.)
Real Estate
(Buildings, Lots, Commercial Property, etc.)
Property Address (physical address)
4a. Value (CMV x 0.8 - Loan Balance)
City
State
ZIP Code
Foreign Country (if not United States)
Current Market Value (CMV)
Multiply CMV by 0.8
Loan Balance
Property Address (physical address)
4b. Value (CMV x 0.8 - Loan Balance)
City
State
ZIP Code
Foreign Country (if not United States)
Current Market Value (CMV)
Multiply CMV by 0.8
Loan Balance
4c. Total property(s) from attachment
4c.
Total of property(s) listed from attachment (CMV x 0.8 - Loan Balance) . . . . . . . . . . . . . . .
4d. Add Lines 4a through 4c
4d.
Total of all property(s) (Add Lines 4a through 4c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Business Vehicles
Vehicle Make
Model
Year
Mileage or
Lease or Loan?
Monthly Lease /
5a. Value (CMV x 0.8 - Loan Balance)
Use Hours
Lease
Loan Payment
If leased, enter -0-
Loan
Current Market Value (CMV)
Multiply CMV by 0.8
Loan Balance
5a. Value (CMV x 0.8 - Loan Balance)
Vehicle Make
Model
Year
Mileage or
Lease or Loan?
Monthly Lease /
Use Hours
Lease
Loan Payment
If leased, enter -0-
Loan
Current Market Value (CMV)
Multiply CMV by 0.8
Loan Balance
5c. Total vehicle(s) from attachment
5c.
Total of business vehicle(s) listed from attachment (CMV x 0.8 - Loan Balance) . . . . . . . .
5d. Add Lines 5a through 5c
5d.
Total of all business vehicle(s) (Add Lines 5a through 5c) . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Business Equipment
Current Market Value (CMV)
Multiply CMV by 0.8
Loan Balance
6a. Value (CMV x 0.8 - Loan Balance)
6b. Total business equipment from attachment
6b.
Total of business equipment listed from attachment (CMV x 0.8 - Loan Balance) . . . . . . . .
6c. Add Lines 6a and 6b
6c.
Total of all business equipment (Add Lines 6a and 6b) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Available Assets
BOX 1
Total Available Assets
BOX 1 Add Lines 1e, 2d, 3, 4d, 5d, and 6c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule OIC-672
(continued on next page)
Page 3 of 6
5454
10/17
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