Form 433-B(Oic) - Collection Information Statement For Businesses - Internal Revenue Service Page 2
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Section 2
Business Asset Information
Gather the most current statement from banks, lenders on loans, mortgages
, monthly payments, loan balances, and
(including second mortgages)
accountant's depreciation schedules, if applicable. Also, include make/model/year/mileage of vehicles and current value of business assets. To estimate
the current value, you may consult resources like Kelley Blue Book ( ), NADA
, local real estate postings of properties
( )
similar to yours, and any other websites or publications that show what the business assets would be worth if you were to sell them. Asset value is
subject to adjustment by IRS. Enter the total amount available for each of the following
.
(if additional space is needed, please include attachments)
Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0".
Cash and Investments
(domestic and foreign)
Cash
Checking
Savings
Money Market/CD
Online Account
Stored Value Card
Bank Name
Account Number
(1a) $
Cash
Checking
Savings
Money Market/CD
Online Account
Stored Value Card
Bank Name
Account Number
(1b) $
Cash
Checking
Savings
Money Market/CD
Online Account
Stored Value Card
Bank Name
Account Number
(1c) $
Total bank accounts from attachment
(1d) $
Add lines (1a) through (1d) =
(1) $
Investment Account:
Stocks
Bonds
Other
Name of Financial Institution
Account Number
Current Market Value
Minus Loan Balance
$
X .8 = $
– $
(2a) $
=
Investment Account:
Stocks
Bonds
Other
Name of Financial Institution
Account Number
Current Market Value
Minus Loan Balance
$
X .8 = $
– $
=
(2b) $
Total investment accounts from attachment. [current market value X.8 minus loan balance(s)]
(2c) $
Add lines (2a) through (2c) =
(2) $
Notes Receivable
Do you have notes receivable?
Yes
No
If yes, attach current listing which includes name, age, and amount of note(s) receivable.
Accounts Receivable
Do you have accounts receivable, including e-payment, factoring
Yes
No
companies, and any bartering or online auction accounts?
If yes, you may be asked to provide a list of name, age, and amount of the account(s) receivable.
433-B (OIC)
Form
(Rev. 3-2017)
Catalog Number 55897B
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