Blank Illinois Boa 4 PDF Form

The Illinois BOA-4 form is a Financial Information Statement designed for individuals to provide detailed financial data to the Illinois Department of Revenue. This form collects essential information regarding personal and financial circumstances, including income, assets, and liabilities. Completing this form accurately is crucial for various tax-related processes, so take the first step by filling it out through the button below.

The Illinois BOA-4 form, officially known as the Financial Information Statement for Individuals, serves a crucial role in gathering detailed financial data from individuals, particularly in the context of state income tax assessments and related financial evaluations. This comprehensive document is structured into several sections, each designed to capture essential personal and financial information. In the first section, individuals provide their personal details, including marital status, employment information, and average monthly income. For those who are married, there is an additional part that requires the spouse's information, ensuring a complete financial picture. The subsequent sections delve into various financial assets, such as bank accounts, credit lines, real property, and insurance policies. Each category requires specific details, including account balances and property descriptions. Furthermore, the form prompts individuals to analyze their assets and liabilities, offering a clear view of their financial standing. It also addresses income sources and necessary monthly expenses, allowing for a thorough assessment of one’s financial health. Completing the BOA-4 form accurately is essential, as it may influence tax obligations and eligibility for certain benefits or programs.

Outline

Document Sample

Illinois Department of Revenue

BOA-4 Financial Information Statement for Individuals

Section 1: Tell us about yourself and your employment

Part A: Your information

1	Marital status		single	married	separated
	If married, complete your spouse’s information in Part B.
2	Your name ___________________________________________ 11						Filing status	single	married filing jointly
3 Street address ________________________________________								head of household	married filing separately
	____________________________________________________ 12						Average monthly take-home pay $___________________________
	City			State	ZIP	13	Amounts withheld from your paycheck (e.g., savings, bonds,
						13	Amounts withheld from your paycheck (e.g., savings, bonds,
4	Home phone (____)____________________________________						deferred amounts, car payments, etc.) $______________________
5	Social Security number		___ ___ ___- ___ ___- ___ ___ ___ ___				______________________________________________________
6	Unemployed	yes	no If “yes,” how long. _______________ 14				Dates paid _____________________________________________
7	Current or former employer’s name ________________________ 15						Length of employment ____________________________________
8	Address _____________________________________________ 16						Date of birth	___ ___/___ ___/___ ___ ___ ___
	____________________________________________________ 17						Name and address of next of kin (other than spouse)
	City			State	ZIP		Name ________________________________________________
							Name ________________________________________________
9	Work phone (_____)____________________________________						Street address _________________________________________
10	Occupation___________________________________________						______________________________________________________
							City		State	ZIP

Part B: Your spouse’s information

18	Spouse’s name _______________________________________ 25					Work phone(_____)______________________________________
19	Address (if different)____________________________________ 26					Occupation ____________________________________________
	____________________________________________________ 27					Average monthly take-home pay $___________________________
	City		State	ZIP	28	Amounts withheld from your paycheck (e.g., savings, bonds,
					28	Amounts withheld from your paycheck (e.g., savings, bonds,
20	Home phone (if different)(_____)__________________________					deferred amounts, car payments, etc.) $______________________
21	Social Security number		___ ___ ___-___ ___-___ ___ ___ ___			______________________________________________________
22	Unemployed	yes	no If “yes,” how long._______________ 29			Dates paid _____________________________________________
23	Current or former employer’s name ________________________ 30					Length of employment ____________________________________
24	Address _____________________________________________ 31					Date of birth ___ ___/___ ___/___ ___ ___ ___
	____________________________________________________
	City		State	ZIP

Section 2: Complete the following financial information

Note: Attach additional sheets in the same format for any of the following parts if necessary.

Part A: Your bank accounts (include savings and loans, credit unions, IRA and retirement plans, and certificates of deposit)

	A	B	C	D	E
			Type of	Account
	Name of institution	Address	account	number	Balance
32	______________________	_______________________________________	___________	___________	____________
33______________________		_______________________________________	___________	___________	____________
34	______________________	_______________________________________	___________	___________	____________
35	______________________	_______________________________________	___________	___________	____________
36	______________________	_______________________________________	___________	___________	____________
37______________________		_______________________________________	___________	___________	____________
38	Add Lines 32 through 37, Column E, and write the total here and on Part G, Line 56, Column B.			38	____________

BOA-4 (R-4/01)

Page 1 of 4

Part B: Your charge cards or credit lines from your banks, credit unions, and savings and loans

	A	B	C
	Type of account		Current
	or card	Name and address of financial institution	balance
39	_________________	_______________________________________________________________________	___________
40	_________________	_______________________________________________________________________	___________
41	_________________	_______________________________________________________________________	___________
42	_________________	_______________________________________________________________________	___________
43	_________________	_______________________________________________________________________	___________
44	Add Lines 39 through 43, Column C, and write the total here and on Part G, Line 57, Column C.		44 ___________

Part C: Real property you own

	A	B	C	D
	Brief description	How property
	of property	is titled	Physical address	County
45	_____________________________	__________________	_______________________________________	___________
46	_____________________________	__________________	_______________________________________	___________
47	_____________________________	__________________	_______________________________________	___________

Part D: Your life and health insurance policies

	A	B	C	D	E
		Policy		Face	Available
	Insurance company	number	Type	amount	loan value
48	__________________________________________________	___________	___________	___________	___________
49	__________________________________________________	___________	___________	___________	___________
50	Add Lines 48 and 49, Column E, and write the total here and on Part G, Line 60, Column B.				50 ___________

Part E: Your securities (e.g., stocks, bonds, annuities, mutual funds, money market funds, government securities, notes, personal, etc.)

	A	B	C	D	E
	Type			Quantity or
	of security	Location	Owner of record	denomination	Present value
51	_________________	______________________________	_________________________	___________	___________
52	_________________	______________________________	_________________________	___________	___________
53	Add Lines 51 and 52, Column E, and write the total here and on Part G, Line 61, Column B.				53 ___________

Part F: Miscellaneous information

54a Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? b What is the bankruptcy number? ______________________

Yes

c What date was the bankruptcy filed? ___ ___/___ ___/___ ___ ___ ___			If closed, what was the date? ___ ___/___ ___/___ ___ ___ ___
Month	Day	Year	Month	Day	Year

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BOA-4 (R-4/01)

Part G: Analyze your assets and liabilities

Note: Write amounts in all unshaded areas that apply

	A	B
		Fair market
	Description	value
55	Cash	___________
56	Total bank accounts
	from Section 2, Part A,
	Line 38	___________

57Total charge cards balance from Section 2, Part B,

Line 44

___________

58Vehicles (model, year)

a ___________________		___________
b ___________________		___________
c ___________________		___________
59	Real property listed
	in Section 2,
	Part C, (Line 45)	___________
	(Line 46)	___________
	(Line 47)	___________
60	Total cash or loan value
	of insurance from
	Section 2, Part D,
	Line 50	___________
61	Total securities from
	Section 2, Part E,
	Line 53	___________
62	Other assets (specify)

Liabilities

balance due

___________

Equity

(Column B minus

Column C)

___________

Monthly payment amount

___________

Pledgee or obligee

___________________

Date of

final

payment

____________

a___________________

b___________________

c___________________

63 Other liabilities not covered above (e.g., judgments, charities, tuition)

a___________________

b___________________

c___________________

64 Federal taxes owed

65 State taxes owed a Illinois individual

income tax

b Illinois business income tax

c Other state taxes

66Total

___________

___________________

____________

BOA-4 (R-4/01)

Page 3 of 4

Part H: Analyze your monthly income and expenses

Income

	A	B	C
	Source	Gross	Net
67	Your wages or salary	___________________	___________________
68	Your spouse’s
	wages or salary	___________________	___________________
69	Interest or dividends	___________________	___________________
70	Business income	___________________	___________________
71	Rental income	___________________	___________________
72	Your pension	___________________	___________________
73	Your spouse’s pension	___________________	___________________
74	Child support	___________________	___________________
75	Alimony	___________________	___________________

76Other (specify)

________________ ___________________ ___________________

________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
77 Add Lines 67 through 76, Column C.
This amount is your total net income.		____________________

Necessary monthly living expenses

A	B
Expense	Amount

78Rent (not included

	in Part G, Line 59)			___________________
79	Groceries
	(number of people____)			___________________
80	Installment pmts. from
	Part G, Line 66, Col. E			___________________
81	Utilities	a	gas	___________________
		b	water	___________________
		c	electric	___________________
		d	telephone	___________________
82	Transportation			___________________
83	Insurance	a	life	___________________
	(monthly	b	health	___________________
	premiums) c		home	___________________
		d	car	___________________

84Medical (not covered

	in Line 83b above)	___________________
85	Estimated tax payments	___________________
86	Court-ordered payments	___________________

87Other (specify)

__________________ ___________________

88Add Lines 78 through 87. This amount is your

total expenses.

___________________

89 Subtract Line 88 from Line 77. This amount is your net income after expenses.

89 ___________________

Part I: Complete any additional asset or income information

90Write any additional information you have about your assets or income that was not included in any of the preceding parts. Be sure to include a statement regarding the prospect of any increase in the value of your assets or your present income.

_____________________________________________________________________________________________________________

Section 3: Sign below

Under penalties of perjury, I state that I have examined this statement of assets, liabilities, and other information and, to the best of my knowledge, it is true, correct, and complete.

______________________________________________/___/_____ ______________________________________________/___/_____

Petitioner’s signature (not representative)

Date

Spouse’s signature

Date

Page 4 of 4

This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide information
could result in this form not being processed. This form has been approved by the Forms Management Center.	IL-492-3683	BOA-4 (R-4/01)

Get Illinois Boa 4

File Specifics

Fact Name	Details
Form Title	Illinois Department of Revenue BOA-4 Financial Information Statement for Individuals
Purpose	This form collects financial information from individuals for various state tax purposes.
Governing Law	Illinois Income Tax Act
Sections	The form includes sections for personal information, financial details, and asset analysis.
Submission Requirement	Disclosure of information is mandatory; failure to provide it may lead to processing issues.
Signature Requirement	The form must be signed by the petitioner and, if applicable, the spouse under penalties of perjury.

How to Use Illinois Boa 4

Filling out the Illinois BOA-4 form requires gathering personal and financial information. This information will help assess your financial situation accurately. Ensure that all details are correct and complete before submission.

Start with Section 1, Part A. Indicate your marital status by checking the appropriate box: single, married, or separated.
Provide your full name in the designated space.
Enter your street address, including city, state, and ZIP code.
List your home phone number and work phone number, if applicable.
Fill in your Social Security number.
Indicate whether you are unemployed and, if so, how long you have been unemployed.
Provide the name of your current or former employer and their address.
State your occupation and length of employment.
Enter your date of birth.
Provide the name and address of your next of kin, excluding your spouse.
If married, complete Part B with your spouse's information, including their name, address, phone numbers, Social Security number, employment details, and financial information.
Move to Section 2 and complete Part A by listing your bank accounts. Include the type of account, institution name, address, account number, and balance for each account.
In Part B, provide details about your charge cards or credit lines, including the type of account, financial institution, and current balance.
In Part C, describe any real property you own, including the title, physical address, and county.
For Part D, list your life and health insurance policies, including policy numbers, types, face amounts, and available loan values.
In Part E, provide details about your securities, including type, quantity, location, owner of record, and present value.
In Part F, answer questions about any pending foreclosure, bankruptcy, or similar proceedings.
Proceed to Part G and analyze your assets and liabilities. Fill in the fair market value of cash, bank accounts, charge card balances, vehicles, real property, insurance, and securities.
Complete Part H by detailing your monthly income sources and expenses. Calculate your total net income and total expenses, and determine your net income after expenses.
In Section 3, sign and date the form. Ensure that both you and your spouse sign if applicable.

Your Questions, Answered

What is the Illinois BOA-4 form?

The Illinois BOA-4 form is a Financial Information Statement specifically designed for individuals. It is used to gather detailed financial information, including income, expenses, assets, and liabilities. This form is often required in various legal and financial contexts, such as during bankruptcy proceedings or when applying for certain financial assistance programs.

Who needs to fill out the BOA-4 form?

Individuals who are involved in legal proceedings, such as bankruptcy or financial assistance applications, may need to complete the BOA-4 form. If you are required to disclose your financial situation for any reason, this form will likely be necessary. Both you and your spouse, if applicable, will need to provide information if you are married.

What information is required in Section 1?

Section 1 of the BOA-4 form asks for personal and employment information. You will need to provide your marital status, name, address, phone numbers, Social Security number, employment details, and information about your next of kin. If you are married, you will also need to fill out your spouse's information in Part B of this section.

How do I report my financial information in Section 2?

Section 2 is divided into several parts where you will report various aspects of your financial situation:

Bank Accounts: List your bank accounts, including savings and loans, with details like the institution's name, account number, and balance.
Charge Cards or Credit Lines: Provide information about any credit cards or lines of credit you have, including the current balance.
Real Property: Describe any real estate you own, including its physical address and how it is titled.
Insurance Policies: Include details about your life and health insurance policies, such as the policy number and face amount.
Securities: Report any stocks, bonds, or other securities you own, including their present value.

What should I do if I have more financial information than the form allows?

If you find that you need more space to provide your financial information, you can attach additional sheets in the same format as the form. This ensures that all necessary details are included and clearly presented.

How is my income assessed in Section 3?

In Section 3, you will analyze your monthly income and expenses. You will list various sources of income, such as wages, rental income, and any other earnings. After calculating your total income, you will also need to detail your necessary monthly living expenses. This includes rent, groceries, utilities, and any insurance payments. The form will guide you through calculating your net income after expenses.

What happens if I do not provide accurate information?

It is crucial to provide accurate and complete information on the BOA-4 form. Under penalties of perjury, you must declare that the information is true to the best of your knowledge. Failing to provide accurate information could lead to the form not being processed or other legal consequences.

Where can I get help with filling out the BOA-4 form?

If you need assistance with the BOA-4 form, consider reaching out to a legal professional or a financial advisor. They can provide guidance on how to accurately complete the form and ensure that all necessary information is included. Additionally, local legal aid organizations may offer resources or assistance for individuals who need help navigating the process.

Common mistakes

Incomplete Personal Information: Many people forget to fill out all sections in Part A and Part B, especially the spouse’s information if applicable. This can lead to processing delays.
Incorrect Financial Data: Providing inaccurate figures for income, expenses, or account balances is a common mistake. Double-check all numbers to ensure they reflect your current financial situation.
Omitting Required Attachments: Some individuals fail to attach necessary documents, such as additional sheets for financial information. Always include any required attachments to avoid complications.
Missing Signatures: Failing to sign the form can result in it being rejected. Both the petitioner and the spouse must sign and date the form where indicated.
Ignoring Instructions: Not following the specific instructions provided for each section can lead to errors. Read the form carefully and adhere to all guidelines to ensure accuracy.

Documents used along the form

When filing the Illinois BOA-4 form, there are several other documents that may be helpful to have on hand. These documents can provide additional information about your financial situation and support your application. Here’s a brief overview of some commonly used forms alongside the BOA-4.

Income Tax Returns: These documents show your income and tax obligations for the past few years. They help verify your earnings and financial history.
Pay Stubs: Recent pay stubs from your employer provide proof of your current income. They detail your earnings and any deductions taken from your pay.
Bank Statements: Statements from your bank accounts can help illustrate your financial stability. They show your account balances and transaction history.
Property Deeds: If you own real estate, property deeds confirm your ownership and can provide information on the value of your assets.
Loan Documents: These include any agreements related to loans or credit lines. They detail your debts and obligations, which are important for assessing your financial situation.
Insurance Policies: Documents related to life or health insurance can provide information on your coverage and any cash value that may be available.

Having these documents ready can streamline the process of completing the BOA-4 form. They provide a clearer picture of your financial situation, making it easier for you to fill out the necessary information accurately.

Similar forms

The Illinois BOA-4 form is similar to the IRS Form 1040, which is the standard individual income tax return form. Both documents require individuals to provide detailed financial information, including income, expenses, and personal details. While the 1040 focuses on federal income tax obligations, the BOA-4 is more oriented towards assessing a person’s financial situation for state tax purposes. Each form plays a crucial role in determining tax liabilities, but they cater to different levels of government and have distinct requirements based on their respective jurisdictions.

Another document that shares similarities with the Illinois BOA-4 is the Bankruptcy Schedule A/B. This form is used during bankruptcy proceedings to list all assets and liabilities. Like the BOA-4, it requires individuals to disclose detailed information about their financial status, including property, bank accounts, and debts. Both forms aim to provide a comprehensive view of an individual's financial situation, although the Bankruptcy Schedule A/B is specifically tailored for legal proceedings related to insolvency.

The Financial Disclosure Statement, often used in divorce proceedings, is another document comparable to the BOA-4. This statement requires individuals to provide a thorough account of their financial circumstances, including income, expenses, and assets. Similar to the BOA-4, it helps determine financial obligations and support payments. Both documents emphasize transparency in financial matters, ensuring that all parties have a clear understanding of the financial landscape.

Lastly, the Illinois Property Tax Appeal Board (PTAB) form is akin to the BOA-4 in that it requires detailed financial information to support appeals related to property taxes. While the BOA-4 focuses on individual financial statements, the PTAB form centers on property valuation and tax assessments. Both forms necessitate comprehensive disclosures of financial data to facilitate accurate evaluations, though they serve different purposes within the realm of taxation.

Dos and Don'ts

When filling out the Illinois BOA-4 form, there are important guidelines to follow. Here’s a list of things you should and shouldn't do:

Do provide accurate personal information, including your name, address, and Social Security number.
Do clearly indicate your marital status and complete the spouse's section if applicable.
Do list all sources of income and ensure the figures are correct.
Do include all bank account details and balances.
Do attach additional sheets if necessary to provide complete information.
Don't leave any required fields blank; fill in all sections as accurately as possible.
Don't use abbreviations or shorthand that may confuse the reviewer.

Misconceptions

Misconception 1: The BOA-4 form is only for individuals with high income.

This form is designed for a wide range of income levels. It is applicable to anyone needing to provide financial information, regardless of their earnings.

Misconception 2: You must be married to fill out the form.

While there is a section for spouse information, single individuals can also complete the BOA-4 form without needing to provide spousal details.

Misconception 3: All financial accounts need to be disclosed on the form.

Only relevant accounts must be reported. Focus on those that impact your financial situation and are necessary for the evaluation process.

Misconception 4: The form is only for those in financial distress.

The BOA-4 form is a standard financial disclosure tool used for various purposes, not solely for individuals facing financial difficulties.

Misconception 5: You can’t make changes once the form is submitted.

If errors are found after submission, you can typically amend the form or provide additional information as needed.

Misconception 6: The form is too complicated to fill out without assistance.

While it may seem daunting, the BOA-4 form is structured in a straightforward manner. Many individuals successfully complete it on their own.

Misconception 7: Submitting the form guarantees financial assistance.

Filling out the BOA-4 form does not automatically result in aid. It is a tool for assessing eligibility, and outcomes depend on various factors.

Key takeaways

Filling out the Illinois BOA-4 form can be a straightforward process if you keep a few key points in mind. Here are some essential takeaways to help you navigate this important document:

Understand the Purpose: The BOA-4 form is designed to provide a comprehensive overview of your financial situation, including income, assets, and liabilities.
Gather Necessary Information: Before starting, collect all relevant financial documents, such as pay stubs, bank statements, and details about any debts or assets.
Complete Personal Information First: Begin with Section 1, where you will provide your personal details, including marital status, employment information, and contact details.
Be Accurate: Ensure that all information is correct and complete. Inaccuracies can lead to delays or complications in processing your form.
Include Spousal Information: If you are married, you must also provide your spouse's financial information in Part B. This includes income and any joint assets.
Detail Your Financial Accounts: In Section 2, list all bank accounts, credit cards, and other financial assets. Be thorough and precise with account numbers and balances.
Review Before Submission: After filling out the form, take a moment to review all sections. Ensure that you have signed and dated the form as required.

By following these guidelines, you can confidently fill out the Illinois BOA-4 form, ensuring that your financial information is presented clearly and accurately.