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Get OR DoR 150-101-159 2017-2023

R(s), officer(s), major shareholder(s), etc. Identify the major responsibilities of each by circling the codes that apply: 1 Files returns; 2 Pays taxes; 3 Prefers creditors; 4 Hires and fires Name and title Effective date Home address Home phone SSN Code 1 2 3 4 1 2 3 4 1 2 3 4 Section 3. General financial information (personal and business) Bank accounts. Include IRA and retirement plans certificates of deposit, etc. For all accounts, attach copies of your last three bank statemen.

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