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First Name Relationship Age Does this person
live with you?
Victoria Daughter 24 : No 9 Yes
Hunter Son 18 9 No : Yes
* * * * * * *
7. Are you or your spouse self-employed or operate a
business? (Check “Yes” if either applies)
9 No : Yes If yes, provide the following
information:
7a. Name of Business Henry M. Lloyd P.C.
* * * * * * *
7e. Do you have accounts/notes receivable? : No 9 Yes
If yes, please complete Section 8 on page 5.
In section 3 of petitioner’s June 24, 2005 Form 433-A,
petitioner indicated that he did not have an employer other than
Henry M. Lloyd, P.C.
In section 4 of petitioner’s June 24, 2005 Form 433-A,
petitioner provided the response indicated to the following
question:
10. Do you receive income from sources other than your
own business or your employer? (Check all that
apply.)
: Pension : Social Security : Other (specify, i.e.
child support, alimony,
rental) Rental
In section 5 of petitioner’s June 24, 2005 Form 433-A,
petitioner indicated that he (1) maintained a checking account
that had a balance of $15,000, (2) owned a brokerage account with
no current account balance, (3) had two credit cards with unspec-
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Last modified: March 27, 2008