Form De 204 - Corporate Information Questionnaire
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1
2CORPORATE INFORMATION QUESTIONNAIRE
1. Account No.
Active
Inactive
Date
Preparer
2. Corporate Name
Corporate I.D. No.
DBA(s)
3. Period of Liability
Total of Liability $
4. Identity of Principal(s), Corporate Officer(s), and/or Stockholder(s):
A. Name
Title
SSA No.
CDL No.
% Stock
Period Involved
Address
B. Name
Title
SSA No.
CDL No.
% Stock
Period Involved
Address
C. Name
Title
SSA No.
CDL No.
% Stock
Period Involved
Address
D. Name
Title
SSA No.
CDL No.
% Stock
Period Involved
Address
5. Was State Disability Insurance/Personal Income Tax withheld? Yes
No
6. Was it placed in a trust account? Yes
No
Provide all bank names, addresses, and bank account numbers
7. Who prepared the quarterly tax returns/deposits?
8. Who signed returns/deposits?
9. Who signed payroll checks?
10. Who signed business checks?
11. Who had the final word as to what bills would be paid?
12. Who was the signator(s) on the account(s)?
13. Number of signatures required?
14. Who managed and directed operations?
15. Who hired/fired employees?
16. Who supervised the employees?
17. Who negotiated contract/business transactions?
18. Who negotiated and guaranteed loans?
19. What business expenses (including wages, loan payments, other taxes) were paid after the liability
became due?
(See page 2 for additional comments)
DE 204 Rev. 5 (10-13) (INTERNET)
Page 1 of 2
CU
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Parent category: Legal