Tax Organizer Template - 2015 Income Tax Return Page 7
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7Insolvency Worksheet
Name of creditor: _______________________________________________________________________
Name of debtor: _______________________________________________________________________
Amount of cancelled debt: $________________________________
Date debt was cancelled (mm/dd/yy): _________________________________________
IMPORTANT ADVICE: Keep the records used to complete this worksheet, such as credit card statements, bank statements,
online values, appraisals, balance sheets, etc.
Amount Owed the
Liabilities
Day Before the
Cancellation
$
1
Credit card debt
$
2
Mortgage(s) on real property (including first and second mortgages and home equity loans) (mortgage(s)
$
3
Car and other vehicle loans
$
4
Medical bills owed
$
5
Student loans
$
6
Accrued or past-due mortgage interest
$
7
Accrued or past-due real estate taxes
$
8
Accrued or past-due utilities (water, gas, electric)
$
9
Accrued or past-due child care costs
$
10
Federal or state income taxes remaining due (for prior tax years)
$
11
Loans owed to IRA accounts, 401(k) accounts and other retirement plans
$
12
Loans against life insurance policies
$
13
Judgments
$
14
Business debts (including those owed as a sole proprietor or partner)
$
15
Margin debt on stocks and other debt to purchase or secured by investment assets other than real property
$
16
Other liabilities (debts) not included above
$
17
Total liabilities immediately before the cancellation. Add lines 1 through 16.
FMV the Day Before
Assets
the Cancellation
$
18
Cash and bank account balances
$
Homes (including the value of land) (can be main home, any additional home, or property held for investment or
19
used in a trade or business)
$
20
Cars and other vehicles
$
21
Computers
$
22
Household goods and furnishings (for example, appliances, electronics, furniture, etc.)
$
23
Tools
$
24
Jewelry
$
25
Clothing
$
26
Books
$
27
Stocks and bonds
$
28
Investments in coins, stamps, paintings, or other collectibles
$
29
Firearms, sports, photographic, and other hobby equipment
$
30
Interest in retirement accounts (IRA accounts, 401(k) accounts, and other retirement accounts)
$
31
Interest in a pension plan
$
32
Interest in education accounts
$
33
Cash value of life insurance (Not the face value of the policy)
$
34
Security deposits with landlords, utilities, and others
$
35
Interests in partnerships
$
36
Value of investment in a business
$
Other investments (for example, annuity contracts, guaranteed investment contracts, mutual funds, commodity
37
accounts, interests in hedge funds, and options)
$
38
Other assets not included above
$
39
FMV of total assets immediately before the cancellation. Add lines 18 through 38.
Signature:______________________________________
Date:______________________________________
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