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Client name (company, estate, individual, ESOP, etc.):
Legal name(s) & title(s) of contract signer(s):
Complete legal name of the entity to be valued:
Valuation date:
State in which the entity has been formed:
City and state where the business is located:
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Contact person (required):
Contact person's firm name (if applicable):
Contact person's address:
Contact person's telephone (required):
Contact person's email address (required):
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Type of entity being valued:
C-corporation
S-corporation
General partnership (GP) or limited
liability partnership (LLP)
Limited partnership (LP) or limited
liability limited partnership (LLLP)
Limited liability company (LLC)
Proprietorship
Other
Description of the ownership interest being
valued (check all that apply):
Common stock
Common stock option
Convertible preferred stock
Straight preferred stock
General partner
Limited partner
LLC member interest
Intangible asset
Other
Purpose of the valuation:
Gift tax
Estate tax
Income tax
ESOP
Divorce
Sale
Dissenter's rights
Other
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Standard of value:
Fair market as defined for federal statutory
valuations
Fair market as defined in the state of formation
Fair value
Investment value
Other
Nature of the business (check all that apply):
Manufacturing
Service provider
Wholesale or distribution
Agriculture
Construction
Retail trade
Holding company owning real estate
Holding company owning marketable securities
Other
Ownership basis:
Controlling ownership interest
Non-controlling (minority) ownership interest
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