Transcription of Collection Information Statement for Individuals
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FormMD 433-A(Rev. July 2000)State of MarylandComptroller of MarylandNote: Complete all blocks, except shaded areas. Write N/A (not applicable) in those blocks that do not Taxpayer(s) name(s) and address2 Home phone number3 Marital status ( )4a Taxpayer s Social Security number4b Spouse s Social Security numberCounty_____Section IEmployment Information5 Taxpayer s employer or businessa How long employedb Business phone numberc Occupation (name and address)d Number of exemptionse Pay period:! Weekly! Bi-weeklyf (Check appropriate box) claimed on W-4! Monthly! _____ ! Wage earner ! Sole proprietor Payday: _____ (Mon-Sun) ! Partner6 Spouse s employer or businessa How long employedb Business phone numberc Occupation (name and address)d Number of exemptionse Pay period:!
Form MD 433-A (Rev. 7-2000) Page 2 Section III (continued) General Financial Information 14 Charge cards and lines of credit from …
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Personal Net Worth Statement, Financial statement, Statement (Support Claims), Real Estate Settlement Procedures Act, Institution, Federal Reserve System, Concentrations in Commercial Real Estate, SIGNING BELOW CONSTITUTES REPRESENTATION, Real, Standard Operating Procedures for Disclosure, Standard Operating Procedures for Disclosure and Management, Financial, FINANCIAL ASSESSMENT WORKSHEET, CURRENT ASSETS CURRENT LIABILITIES