Personal Financial Statement Form - State Of Maine Revenue Services Page 2
Download a blank fillable Personal Financial Statement Form - State Of Maine Revenue Services in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Personal Financial Statement Form - State Of Maine Revenue Services with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Taxpayer Name:
SSN:
ASSETS (continued)
Stocks, Bonds, Mutual Funds and Other Securities
Type
Where located
Owner of record
Current value
Life Insurance
Name of company
Policy number
Cash surrender value
Loan value
Vehicles
Year
Make & model
Owned or leased?
Lien/leaseholder
Amount owed
Monthly payment
Collectibles
Description of items collected
Location of collection
Estimated value of collection
Other Assets
Income tax refunds
Average annual federal refund
Anticipated current year refunds
Federal
State
Boats, snowmobiles, ATVs, riding lawnmowers, farm or construction equipment
Item description
Location
Lien holder
Current value
Amount owed
Other property not listed above
Item description
Location
Lien holder
Current value
Amount owed
LIABILITIES
Federal Tax Debts
Tax type
Amount owed
Monthly payment
Is this debt currently under levy by the IRS?
Yes
No
Do you have an offer-in-compromise pending with the IRS?
Yes
No
Do you have a petition for reconsideration pending with the IRS?
Yes
No
Non-Maine State Tax Debts
Tax type
Amount owed
Monthly payment
To which state is this debt owed?
Is debt currently under collection in Maine’s courts?
Yes
No
Do you have an offer-in-compromise pending with that state?
Yes
No
Do you have a petition for reconsideration pending with that state?
Yes
No
Loans
List all outstanding loans not listed anywhere above
Source of loan (financial institution, family, friend, etc)
Amount owed
Monthly payment
Did you sign a written agreement for this loan?
2
Rev 03/27/2009
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial