Pa2 Collection Information Statement For Businesses Page 3
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1
2
3
4Asset and Liability Analysis
Description
Current
Liabilities
Equity
Amount of
Name and Address of
Date
Date of
Market
Balance
in
monthly
Lien/Note Holder/Obligee
Pledged
Final
Value
Due
Asset
payment
Payment
Cash on hand
Bank accounts
Accounts/Notes Receivable
Life Insurance loan value
a.
Real
b.
Property
c.
d.
a..
Vehicles
b.
(Model,
year, and
c.
license)
d.
Machinery
a.
and
b.
equipment
(Specify)
c.
d.
Merchandise
a.
inventory
(Specify)
b.
Other assets
a.
(Specify)
b.
a.
b.
Other
liabilities
c.
(including
notes, and
d.
judgments)
e.
f.
g.
h.
Federal taxes owed
Total
Income and Expense Analysis
The following information applies to income and expenses during the period
To _________________
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