Ro 1062 Form PDF Details

Understanding the intricacies of the Form RO-1062, provided by the North Carolina Department of Revenue, is crucial for individuals looking to comprehensively outline their financial situation. This multi-page document serves a pivotal role for taxpayers by collecting detailed information regarding personal, employment, and financial aspects, including assets, liabilities, and other significant fiscal data. The form meticulously gathers taxpayers' names, addresses, social security numbers, marital status, and dependents' details in the initial sections, ensuring a holistic view of the individual's personal context. Employment and income details are then explored, requiring information about both the taxpayer's and their spouse's employers, occupation types, and income sources. The form delves deeper into the financial landscape of an individual by requiring disclosures about liquid assets, investment accounts, real property, licensed assets like vehicles, other personal assets, liabilities including secured and unsecured debts, and even anticipates future financial changes. Additionally, it serves as a tool for assessing monthly income versus living expenses, helping to paint a clear picture of the taxpayer’s financial health. Sections dedicated to self-employed individuals require further specifics about business operations. Completing this form accurately is not only a testament to transparency but also aids in gaining a clearer understanding of one’s financial standing, which is paramount for resolving any tax-related matters efficiently.

QuestionAnswer
Form NameRo 1062 Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesirs form 1062, ro 1062 form, fillable ncdor form ro 1062, form 1062 irs

Form Preview Example

Form RO-1062

Web-fill (Rev. 4-10)

N.C Department of Revenue

Collection Information Statement for Individuals

 

 

 

 

Note: Complete all blocks, except shaded areas. Write "N/A" (not applicable) in those blocks that do not apply.

1.

Taxpayers' names and address (including County)

 

 

2a. Home phone number

 

 

 

3a. Taxpayer's social security number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3b. Spouse's social security number

 

 

 

 

 

 

 

 

 

 

2b. Cell phone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4a. Taxpayer's date of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

# of years at this address

 

 

2c. Business phone number

 

 

 

4b. Spouse's date of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Own

 

 

Rent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 1.

 

 

 

 

 

Personal Information

 

 

 

 

 

 

5.

Do you have a power of attorney for tax matters?

If yes, please attach a copy.

Marital Status:

 

 

 

 

 

yes

 

 

 

no

 

 

 

 

 

married

 

unmarried (single, divorced, widowed)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Age and relationship of dependents (exclude yourself and spouse) living in your household.

Section 2.

 

Employment Information

 

 

 

 

7.

Taxpayer's employer or business

 

7a.

How long employed

7c.

Occupation

7e.

(Check appropriate box)

 

(name and address)

 

 

 

 

 

 

 

 

Wage earner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7b.

Number of exemptions

7d.

Paydays

 

 

Sole proprietor

 

 

 

 

claimed on Form NC-4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Partner/Member

 

 

 

 

 

 

 

 

 

 

 

8.

Spouse's employer or business

 

8a.

How long employed

8c.

Occupation

8e.

(Check appropriate box)

 

(name and address)

 

 

 

 

 

 

 

 

Wage earner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8b.

Number of exemptions

8d.

Paydays

 

 

Sole proprietor

 

 

 

 

claimed on Form NC-4

 

 

 

 

 

Business phone #

 

 

 

 

 

 

 

 

Partner/Member

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Latest filed income tax

10. Number of exemptions

11. Adjusted Gross Income

 

 

 

return (tax year)

claimed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 3

 

Liquid Assets

 

 

 

 

 

 

12.Cash on hand

13.Bank accounts (Include Savings & Loans, Credit Unions, Certificates of Deposit, etc.)

Name of Institution

Address

Type of Account

Account No.

3 month average

 

 

 

 

ending balance

13a.

13b.

13c.

13d.

13e. Total

14. Investment Accounts

Include stocks, bonds, mutual funds, stock options, certificates of deposit, and retirement assets such as IRAs, Keogh, and 401(k) plans.

Include all corporations, partnerships, limited liability companies or other business entities in which the individual is an officer, director, owner, member, or otherwise has a financial interest.

 

 

 

 

Loan Balance

 

 

 

 

 

(if applicable)

 

Type of Investment

Full Name & Address(City, State, Zip Code)

Current

As of

 

 

Equity

or Financial Interest

of Company

Market Value

 

mm/dd/yyyy

Value Minus Loan

14a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14d.

Total Equity (Add lines 14a through 14c and amounts from any attachments)

 

 

 

 

 

Form RO-1062 page 1 (Rev. 4-10)

15. Life Insurance (Name of Company)

 

Policy Number

Type

Face Amount

Available Cash Value

 

 

 

 

 

 

15a.

 

 

 

 

 

 

 

 

 

 

 

15b.

 

 

 

 

 

15c. Total

 

 

 

 

 

Section 4

Real Property

 

 

 

16.Real property owned, rented, and leased. Include all real property and land contracts. (For personal and business use if sole proprietor) 16a. Primary Residence

Purchase/Lease Date

 

 

County

Current Fair Market

Current Loan

Amount of Monthly

Date of Final

Equity

 

(mm/dd/yy)

 

Tax Value

 

Value (FMV)

Balance

Payment

Payment

FMV minus loan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property Location (Street, Address, State, ZIP code)

 

 

 

Lender/Lessor/Landlord Name, Address, (Street, Address, State, ZIP code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property County

 

 

 

 

 

 

 

Landlord/Lessor Phone Number

 

 

 

 

First Mortgage Holder

 

 

 

 

 

 

 

Second Mortgage/Home Equity Line

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16b.

Property Description

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purchase/Lease Date

 

 

County

Current Fair Market

Current Loan

Amount of Monthly

Date of Final

Equity

 

(mm/dd/yy)

 

Tax Value

 

Value (FMV)

Balance

Payment

Payment

FMV minus loan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property Location (Street, Address, State, ZIP code)

 

 

 

Lender/Lessor/Landlord Name, Address, (Street, Address, State, ZIP code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property County

 

 

 

 

 

 

 

Landlord/Lessor Phone Number

 

 

 

16c. Total Fair Market Value

 

16d. Total Current Loan Balance

 

16e. Net Equity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach additional sheets as needed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 5.

 

 

 

 

 

Licensed Assets/Vehicles

 

 

 

 

 

17.

Vehicles Purchased Include boats, RVs, motorcycles, trailers, etc. (For personal and business use if sole proprietor)

 

 

 

 

17a. Description

 

Purchase Date

Current Fair Market

Current Loan

Amount of Monthly

Date of Final

Equity

 

(Make, Model,

 

(mm/dd/yy)

 

Value (FMV)

Balance

Payment

Payment

FMV minus loan

 

Year, Mileage)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lender/Lessor Name, Address, (Street, Address, State, ZIP code)

 

 

 

Make

Model

Year

 

 

Mileage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17b. Description

 

Purchase Date

Current Fair Market

Current Loan

Amount of Monthly

Date of Final

Equity

 

(Make, Model,

 

(mm/dd/yy)

 

Value (FMV)

Balance

Payment

Payment

FMV minus loan

 

Year, Mileage)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lender/Lessor Name, Address, (Street, Address, State, ZIP code)

 

 

 

Make

Model

Year

 

 

Mileage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17c. Description

 

Lease Date

Current Fair Market

Current Loan

Amount of Monthly

Date of Final

Equity

 

(Make, Model,

 

(mm/dd/yy)

 

Value (FMV)

Balance

Payment

Payment

FMV minus loan

 

Year, Mileage)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lender/Lessor Name, Address, (Street, Address, State, ZIP code)

 

 

 

Make

Model

Year

 

 

Mileage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17d. Total Current Fair Market Value

 

17e. Total Current Loan Balance

 

17f. Net Equity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form RO-1062 page 2 (Rev. 4-10)

Section 6.

 

 

 

 

 

 

 

 

Other Personal Assets

 

 

 

 

 

 

 

 

 

18. Other Assets (Include all assets listed on homeowners insurance policy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current

 

Liabilities

 

 

Equity

 

Amount of

 

 

 

 

 

 

 

 

Date of

Description

 

Market

 

Balance

 

 

In

 

Monthly

 

Name and Address of

 

 

Date

 

Final

 

 

 

Value

 

Due

 

 

Asset

 

Payment

 

Lien/Note Holder/Obligee

 

 

Pledged

 

Payment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18c .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18d. Total Current Fair Market Value

 

18e. Total Current Loan Balance

 

 

18f. Net Equity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 7.

 

 

 

 

 

Judgments & Secured Liens (other secured debts)

 

 

 

 

 

 

19. Other Liabilities (Include judgments and any secured debt)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Liabilities

 

 

 

 

Amount of

 

 

 

 

 

 

 

 

 

 

Date of

Description

 

Balance

 

 

 

 

Monthly

 

 

 

Name and Address of

 

 

 

Date

 

Final

 

 

 

 

Due

 

 

 

 

Payment

 

 

Lien/Note Holder/Obligee

 

 

Pledged

 

Payment

19a. IRS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance Due

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 8.

 

 

 

 

 

 

 

 

Notes, Charge Accounts and Medical Expenses

 

 

 

 

 

 

20. Available Credit (list bank charge cards, credit unions, lines of credit, medical expenses)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account

 

 

 

 

Name and Address of

 

 

Monthly

 

Credit

Amount

Credit

 

or Card

 

 

 

 

Financial Institution

 

 

Payment

 

Limit

Owed

Available

20a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20e. Total Credit Available

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 9.

 

 

 

 

 

 

 

 

Other Financial Information

 

 

 

 

 

 

 

21. Other information relating to your financial condition. If you check the yes box, please give dates and explain under remarks.

 

 

 

 

 

 

a. Court proceedings

 

 

 

 

 

Yes

 

 

No

b. Bankruptcies

 

 

 

Yes

 

No

Remarks:

 

 

 

 

 

 

 

 

 

 

 

Remarks:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. Repossessions

 

 

 

 

 

Yes

 

 

No

d. Recent transfer of assets

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

for less than full value

 

 

 

 

 

 

 

Remarks:

 

 

 

 

 

 

 

 

 

 

 

Remarks:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. Anticipated increase in income

 

 

Yes

 

 

No

f. Participant or beneficiary to trust,

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

estate, profit sharing, etc.

 

 

 

 

 

 

 

Remarks:

 

 

 

 

 

 

 

 

 

 

 

Remarks:

 

 

 

 

 

 

 

 

 

g. Do you receive government assistance

 

 

h. Are all required state tax returns filed?

 

based on disability and/or financial need?

Yes

No

Yes

No

Remarks:

Remarks:

Form RO-1062 page 3 (Rev. 4-10)

22.Number in Household

23.# Cars

24.# Car Loans

25.County

 

Section 10.

Monthly Income and Expense Analysis

 

 

INCOME

 

Source

Net

26.Wages/ Salaries ( Taxpayer) * Attach copy of most recent pay stub

27.Wages/Salaries (Spouse) * Attach copy of most recent pay stub

28.Rent paid to taxpayer

29.Other members of household

30.Pension(s)

31.Social Security

32.Profit from Business

33.Commissions

34.Other Income

35.Total Income

NECESSARY LIVING EXPENSES

 

 

Source

Amount

 

Source

Amount

 

 

 

 

 

 

 

 

36.

Mortgage/Rent

 

42.

Auto loans

 

37.

Utilities

 

43.

Health/Life Insurance

 

 

 

 

 

 

 

 

 

 

A. Telephone/Cell

 

44.

Medical

 

 

 

 

 

 

 

 

 

 

B. Electricity

 

45.

IRS Tax Payments

 

 

 

C. Heating

 

46.

Miscellaneous Payments

 

 

 

 

 

 

 

 

 

 

D. Water/Garbage

 

 

A. Child Support

 

 

38.

Homeowner/renter insurance

 

 

B. Alimony

 

39.

Groceries

 

 

C. Daycare

 

 

 

 

 

 

 

 

 

40.

Gas/Maintenance, etc.

 

 

D. Estimated tax

 

 

41.

Auto Insurance

 

47. Total Expenses

 

Calculated Disposable Income (total income less total expenses)

Expenses not generally allowed: We generally do not allow tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions, payments on unsecured debts such as credit card bills, cable television and other similar expenses. However, we may allow these expenses if it is proven that they are necessary for the health and welfare of the individual or family or for the production of income.

 

Under penalties of perjury, I declare that to the best of my knowledge and belief this

Certification

statement of assets, liabilities, and other information is true, correct and complete.

Your signature

Spouse's signature (if joint return was filed)

Date

Attachments Required for Wage Earners and Self-Employed Individuals:

Copies of the following items for the last 3 months from the date this form is submitted. (check all the attached items)

Income- Earnings statements, pay stubs, etc. from each employer, pension/social security/other income, self employment income (commissions, invoices, sales, records, etc. and business financial statement if self-employed.)

Banks, Investments, and Life Insurance - Statements for all money market, brokerage, checking and savings accounts, certificates of deposit, IRA, stocks/bonds, and life insurance policies with a cash value.

Assets - Statements from lenders on loans, monthly payments, payoffs, and balances for all personal and business assets. Include copies of UCC financing statements and accountant's depreciation schedules.

Expenses - Bills or statements for monthly recurring expenses of utilities, rent, insurance, property taxes, phone and cell phone, insurance premiums, court orders requiring payments (child support, alimony, etc.), other out of pocket expenses.

Other - credit card statements, profit and loss statements, all loan payoffs, etc.

A copy of last year's Form 1040 with all attachments. Include all Schedules K-1 from Form 1120S or Form 1065, as applicable.

Form RO-1062 page 4 (Rev. 4-10)

Sections 11 and 12 must be completed only if the taxpayer is SELF-EMPLOYED

 

Section 11.

 

 

Business Information

 

 

 

 

 

 

 

 

 

 

48.

Is the business a sole proprietorship (filing Schedule C)

 

 

Yes, Continue with Sections 11 and 12.

 

 

No, Complete Business Financial Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All other business entities, including limited liability companies, partnerships or corporations, must complete business financial statement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49. Business Name

 

 

 

50. Employer Identification Number

 

 

51. Type of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal or State Contractor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52. Business Website

 

 

 

53. Total Number of Employees

 

 

54a. Average Gross Monthly Payroll

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54b. Frequency of Tax Deposits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55.

Does business engage in e-Commerce (Internet sales)

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment Processor (e.g., PayPal, Authorize.net, Google Checkout, etc.) Name and Address (Street, City, State, Zip code)

 

 

 

 

Payment Processor Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Cards Accepted by the Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Card

 

Merchant Account Number

 

 

 

Merchant Account Provider, Name & Address (Street, City, State, ZIP code)

57a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58.

Business Cash on Hand. Include cash that is not in a bank

 

 

 

 

 

 

 

 

Total Cash on Hand

 

 

$

 

 

 

 

Business Bank Accounts. Include checking accounts, online bank accounts, money market accounts, savings accounts, and stored value

 

 

 

cards (e.g. payroll cards, government benefit cards, etc.) Report Personal Accounts in Section 3.

 

 

 

 

 

 

 

 

 

 

 

Type of

Full Name & Address (Street, City, State, ZIP code) of Bank,

 

 

Account Number

 

Account Balance

 

Account

Savings & Loan, Credit Union or Financial Institution.

 

 

 

 

 

 

 

 

 

As of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

mm/dd/yyyy

59a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59c.

Total Cash in Banks (Add lines 59a, 59b, and amounts from any attachments)

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accounts/Notes Receivable. Include e-payment accounts receivable and factoring companies, and any bartering or online auction accounts.

 

 

 

(List all contracts separately, including contracts awarded, but not started.)

Include Federal and State Government Contracts.

 

 

 

 

 

 

 

 

 

 

Status (e.g., age,

 

Date Due

Invoice Number or Federal

 

 

Accounts/Notes Receivable & Address (Street, City, State, ZIP Code)

 

 

factored, other)

 

(mm/dd/yyyy)

or State Government Contract

Amount Due

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60c.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60d.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60e. Total Outstanding Balance (Add lines 60a through 60d and amounts from any attachments)

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form RO-1062 page 5 (Rev. 4-10)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Assets. Include all tools, books, machinery, equipment, inventory or other assets used in trade or business. Include Uniform Commercial Code (UCC) filings. Include Vehicles and Real Property owned/leased/rented by the business, if not shown in Section 10.

 

 

 

Current Fair

 

Amount of

Date of Final

 

 

 

Purchase/Lease/Rental

Market Value

Current Loan

Monthly

Payment

Equity

 

 

Date (mm/dd/yyyy)

(FMV)

Balance

Payment

(mm/dd/yyyy)

FMV Minus Loan

61a.

Property Description

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Location (Street, City, State, ZIP code) and County

\

Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code) and Phone

 

 

 

 

 

 

 

61b.

Property Description

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

Location (Street, City, State, ZIP code) and County

\

Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code) and Phone

 

 

 

 

 

 

 

 

61c. Total Equity (Add lines 61a, 61b and amounts from any attachments

$

Section 12 must be completed only if the taxpayer is SELF-EMPLOYED

Section 12. Sole Proprietorship Information (lines 62 through 83 should reconcile with business Profit and Loss Statement)

Accounting Method Used:

 

Cash

 

 

 

Income and Expenses during the period (mm/dd/yyyy)

Accrual

to (mm/dd/yyyy)

 

Total Monthly Business Income

 

 

 

 

Source

Gross Monthly

 

Expense Items

Actual Monthly

 

 

 

 

 

 

62.

Gross Receipts

 

72.

Materials Purchased

 

63.

Gross Rental Income

 

73.

Inventory Purchased

 

64.

Interest

 

74.

Gross Wages & Salaries

 

 

 

 

 

 

 

65.

Dividends

 

75.

Rent

 

66.

Cash

 

76.

Supplies

 

 

 

 

 

 

 

 

Other Income (Specify Below)

 

77.

Utilities/Telephone

 

67

 

 

78.

Vehicle Gasoline/Oil

 

68

 

 

79.

Repairs & Maintenance

 

 

 

 

 

 

 

69

 

 

80.

Insurance

 

70

 

 

81.

Current Taxes

 

 

 

 

 

 

 

71.

Total Income

 

82.

Other Expenses, including installment payments

 

 

 

 

 

 

 

 

Add lines 62 through 70

 

83.

Total Expenses (Add lines 72 through 82)

 

 

 

 

84.

Net Business Income (line 71 minus 83)

 

 

 

 

 

 

 

Enter the amount from line 84 on line 32, Section 10. If line 84 is a loss, enter "0" on line 32, Section 10.

Self-employed taxpayers must return to page 4 to sign the certification and include all applicable attachments.

Materials Purchased: Materials are items directly related to the production of a product or service.

Current Taxes: Real estate, state, and local income tax, excise, franchise, occupational, personal property, sales and the employer's portion of the employment taxes.

Inventory Purchased: Goods bought for resale.

Supplies: Supplies are items used to conduct business and are consumed or used up within one year. This could be the cost of books, office supplies, professional equipment, etc.

Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone and cell phone.

Net Business Income: Net profit from Form 1040, Schedule C may be used if duplicated deductions are eliminated (e.g., expenses for business use of home already included in housing and utility expenses on page 4). Deductions for depreciation and depletion on Schedule C are not cash expenses and must be added back to the net income figure. In addition, interest cannot be deducted if it is already included in any other installment payments allowed.

FINANCIAL ANALYSIS OF COLLECTION POTENTIAL

 

 

FOR INDIVIDUAL WAGE EARNERS AND SELF-EMPLOYED INDIVIDUALS

 

(DOR USE ONLY)

 

 

 

Cash Available

 

 

(Lines 12, 13e, 14d, 15c, 20e, 58, 59c, 60e)

Total Cash

$

Distrainable Asset Summary

 

 

(Lines 16e, 17e, 18f, 61c)

Total Equity

$

Monthly Total Positive Income minus Expenses

 

 

(Line 35 minus Line 47)

Monthly Available Cash

$

 

 

 

Form RO-1062 page 6 (Rev. 4-10)

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1. It is crucial to fill out the form 1062 irs correctly, so be careful when filling in the areas comprising these particular fields:

nc state form r0 1062 completion process outlined (portion 1)

2. Soon after completing the last section, head on to the next part and fill out the essential particulars in all these fields - Latest filed income tax, return tax year, Number of exemptions, Adjusted Gross Income, claimed, Section Cash on hand Bank, Liquid Assets, Name of Institution, Address, Type of Account, Account No, month average ending balance, e Total, Investment Accounts, and Include stocks bonds mutual funds.

Completing part 2 of nc state form r0 1062

3. The next step is fairly easy, Life Insurance Name of Company, Policy Number, Type, Face Amount, Available Cash Value, c Total Section Real property, Real Property, a Primary Residence, PurchaseLease Date, mmddyy, County, Tax Value, Current Fair Market, Current Loan, and Amount of Monthly - all of these form fields has to be completed here.

Part # 3 for submitting nc state form r0 1062

Those who work with this form generally make mistakes when completing Real Property in this section. Be certain to double-check whatever you type in here.

4. To go onward, the next part involves completing a couple of empty form fields. Included in these are Property Location Street Address, LenderLessorLandlord Name Address, Property County, LandlordLessor Phone Number, c Total Fair Market Value, d Total Current Loan Balance, e Net Equity, Section, Vehicles Purchased Include boats, Attach additional sheets as needed, Licensed AssetsVehicles, a Description, Purchase Date, Current Fair Market, and Current Loan, which are vital to moving forward with this document.

Completing segment 4 of nc state form r0 1062

5. This final step to conclude this document is critical. You must fill out the required form fields, including d Total Current Fair Market Value, e Total Current Loan Balance, f Net Equity, and Form RO page Rev, prior to finalizing. Neglecting to do it can contribute to a flawed and possibly unacceptable document!

Completing part 5 in nc state form r0 1062

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