Offer In Compromise Application - Tennessee Department Of Revenue Page 11
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25Page 11
CS-14B
SECTION IV - ASSETS
$
TOTAL (Enter also on Page 3, Item 30-A)
22. Cash
23. Bank or Credit Union Accounts (Checking, Savings, Certificate of Deposit, etc.)
Type of Account
Name of Institution
Account Number
Balance
$
TOTAL (Enter also on Page 3, Item 30-B)
$
24. Bank Credit Cards (i.e., Visa, Mastercard, Discover, American Express, etc.
Credit
Amount
Credit
Name of Issuer
Account Number
Limit
Owed
Available
$
TOTAL (Enter also on Page 3, Item 30-C) $
25. Securities (Stocks, Bonds, Mutual Funds, IRA, Government Securities, Money Market Funds, etc.)
Quantity or
Current
Type
Issuer
Value
Denomination
$
TOTAL (Enter also on Page 3, Item 30-D) $
26. Real Property (Personal Residence, Vacation or Second Home, Investment Property, Unimproved Land, etc.)
Current Market
Equity In
Amount
Address
Description
Value
Owed
Property
$
TOTAL (Enter also on Page 3, Item 30-E) $
27. Vehicles - Excluding Leased Vehicles (Including Motorhomes, Campers, Motorcycles, Boats, Trailers, etc.)
Tag
Current Market
Equity In
Amount
Description
Make
Model
Year
Number
Value
Owed
Vehicle
$
TOTAL (Enter also on Page 3, Item 30-F) $
28. Other Assets
Current
Current
Appraised Value
Appraised Value
$
Notes Receivable
$
Timber, Mineral or Drilling Rights
Patents or Copyrights
Cash Surrender Value of Life Insurance
Judgments or Settlements Receivable
Other (Specify)
Vested Retirement Account
Collectables, Antiques or Artwork
$
TOTAL (Enter also on Page 3, Item 30-G)
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