Form Eg-13-I Financial And Other Information Statement For Individuals Page 2

Download a blank fillable Form Eg-13-I Financial And Other Information Statement For Individuals in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Eg-13-I Financial And Other Information Statement For Individuals with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Step 4: Complete the following statement of assets and liabilities

Monthly

Date of

Amount of

Present

Liabilities

payment

first

final

equity or asset

Description

value

Balance due

amount

Pledgee or obligee

payment

(Col. A minus B)

Bank accounts

_________

__________________

________

_________

__________________

________

Household furniture

_________

__________________

________

Home mortgage

Rental properties

_________

__________________

________

_________

__________________

________

Real property

Vehicles (model/year)

a __________________

_________

__________________

________

b __________________

_________

__________________

________

Other assets (describe)

a __________________

_________

__________________

________

b __________________

_________

__________________

________

Federal taxes outstanding

_________

__________________

________

_________

__________________

________

State taxes outstanding

_________

__________________

________

Accounts/notes payable

Charge cards

a __________________

_________

__________________

________

b __________________

_________

__________________

________

Other (include judgments)

a __________________

_________

__________________

________

b __________________

_________

__________________

________

_________

Total

Step 5: Complete the following monthly income and expense analysis

Household monthly income

Monthly expenses

Source

Net

Expense

Amount

Your take home pay

___________________

Rent (if no home mortgage in Step 4) ___________________

Your spouse’s take home pay

___________________

Groceries

___________________

Pensions

___________________

Monthly payments (from Line 28)

___________________

Rental income

___________________

Utilities

___________________

Other (specify)

Auto expenses (i.e., insurance, gas)

___________________

________________

___________________

Child support paid

___________________

________________

___________________

Other (specify)

________________

___________________

________________

___________________

________________

___________________

Add Lines 29 through 33.

Add Lines 35 through 41.

This amount is your total net income.

____________________

This amount is your total expenses.

___________________

Subtract Line 42 from Line 34. This amount is your monthly net income after expenses.

___________________

Step 6: Sign below

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

and complete.

Debtor’s signature______________________________________________________________ Date ___ ___/___ ___/___ ___ ___ ___

Spouse’s signature_____________________________________________________________ Date ___ ___/___ ___/___ ___ ___ ___

This form is authorized as outlined by the Illinois Income Tax Act and the Retailers’ Occupation and related occupation taxes and fees acts.

Disclosure of this information is REQUIRED. Failure to provide information could result in this form not being processed.

EG-13-I back (R-5/12)

Reset