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Do/Does you or your household own any automobiles, trucks, minivans, vans or SUVs which were not used entirely for business?
* IF YES - Read each item on list
Do you own any . . .
For definitions Information Booklet »
Do/Does you or your household own any other types of vehicles which are not used entirely for business?
* IF YES - Read each item on list
Do you own any . . .
Have/Has you or your household purchased any [other] vehicles since the first of the reference month for someone outside of your household?
* IF YES -
What kind of vehicle(s) did you purchase?
Have/Has you or your household disposed of [any/any automobiles or] other vehicles since the first of the reference month?
* IF YES -
Which kind of vehicle(s) did you dispose of?
What is/was the model year of the vehicle? [enter value] _____________
What is/was the make and model of this vehicle?
* If vehicle make and model is not found, please specify: [enter text] _____________
* Specify: [enter text] _____________
Is it fueled by-
* Specify: [enter text] _____________
Was/Is it used for business?
What percentage of the mileage was/is counted as a business expense? [enter value] _____________
Was it new or used when acquired?
Was this vehicle -
Was this vehicle purchased from a private individual?
In what month was it purchased? [enter text] _____________
In what year was it purchased? [enter value] _____________
Was any portion of the purchase price financed?
On the first of the reference month, were there remaining loan payments?
Was a trade-in allowance received?
How much? [enter value] _____________
What was the amount paid for the vehicle after [trade-in allowance], rebate, and discount?
*Include destination fee in the price. [enter value] _____________
Did this include sales tax?
What was the amount of the cash down payment? [enter value] _____________
Was the source of credit a Home Equity Loan?
How much was borrowed, excluding any interest? [enter value] _____________
What was the interest rate? [enter value] _____________
In what year was or will the first payment be made? [enter value] _____________
In what month was or will the first payment be made? [enter text] _____________
For how many months was the payment contract? [enter value] _____________
What is your monthly payment amount? [enter value] _____________
How did you dispose of the vehicle?
* Specify: [enter text] _____________
In what month was it sold/traded in/given away to someone outside the household/damaged beyond repair/stolen/disposed of?[enter text] _____________
If sold, how much did you sell it for? [enter value] _____________
Were you reimbursed for the value of the vehicle?
How much did you receive? [enter value] _____________
Do you expect to be reimbursed for the value of the vehicle?
How much will you receive? [enter value] _____________
Were there any outstanding loans on the vehicle when it was [fill: sold/traded in/given away or donated to someone outside household/ damaged beyond repair/stolen/other]?
Were any final payments made on the loan?
How much was the final payment? [enter value] _____________
Did you or your household purchase or acquire any other vehicle?/Do/Does you or your household own any other vehicle?/Did you or your household purchase any other vehicle for someone outside your household?/Did you or your household dispose of any other vehicle?
End of Section 11
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Last Modified Date: April 5, 2010