Collection Information For Businesses Page 3
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4Section Two: Asset and Liability Analysis
Description
Current
Liabilities
Equity
Amount of
Date of
Name and Address of
Date
Market
Balance
in
Monthly
Final
Lien/Note Holder/Obligee
Value
Due
Asset
Payment
Pledged
Payment
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
15. Cash
$
16. Bank Accounts (from item 9)
Accounts/Notes Receivable
17.
(from item 14)
Life Insurance Loan Value
18. (from item 12)
$
$
$
a
19. Real
b
Property
c
d
20. Vehicles
Model, Year,
License
21. Machines
and
Equipment
(Specify)
22. Merchan-
dise
Inventory
(Specify)
23. Other
Assets
(Specify)
(from item
10)
24. Other
Liabili-
ties
(included
notes
and
judg-
ments)
(from
item 10)
25. Federal Taxes Owed
26. State Taxes Owed
27. Total
FORM TC803C 1/96
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