Collection Information For Businesses Page 2
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4SECTION I, General Financial Information - Continued
11.
Real Estate: (Enter values, balance due, equity in asset, and monthly payment in item 19.)
Brief Description and Type of Ownership
Address (Include County and State)
a.
b.
c.
12. Life Insurance Policies Owned with Business as Beneficiary
Accumulative
Name Insured
Company
Policy Number
Type
Face Amount
Cash Value
$
$
12. Total (Enter in Item 18)
13. Additional Information Regarding Financial Condition (court proceedings, bankruptcies filed or anticipated, transfers of
assets for less than full value, changes in market conditions, etc.; including information regarding company participation
in trusts, estates, profit-sharing plans, etc.)
14.
Accounts/Notes Receivable (Include loans to stockholders, officers, partners, etc.)
Name
Address
Amount Due
Date Due
Status
$
14, Total (Enter in Item 17)
$
FORM TC803B 1/96
For additional information, you may access the Tax Commission's World Wide Home Page at:
If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 or Telecommunication Device for the
Deaf (801) 297-3819. Please allow three working days for a response.
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