Iowa Department of Revenue
2014 IA 6251B
https://tax.iowa.gov
Balance Sheet/Statement of Net Worth
As of ________________________
SSN
Name(s)
Part A: Assets
1.
Total Cash .....................................................................................................
1.
2.
Securities .......................................................................................................
2.
3.
Pensions, IRAs, and Social Security Benefits ..........................................
3.
4.
Insurance Policies ........................................................................................
4.
5.
Accounts Receivable ....................................................................................
5.
6.
Inventory, including crops, livestock, other farm animals, and poultry.
6.
7.
Real Property ................................................................................................
7.
8.
Machinery and Equipment ...........................................................................
8.
9.
Vehicles .........................................................................................................
9.
10.
Other Personal Property ..............................................................................
10.
11. Total Assets. Add lines 1-10 ........................................................................... 11.
Part B: Liabilities
12.
Current Liabilities ..........................................................................................
12.
13.
Long-Term Liabilities ....................................................................................
13.
14.
Accrued Taxes ..............................................................................................
14.
15. Total Liabilities. Add lines 12-14 ..................................................................... 15.
Part C: Net Worth
16.
Total Assets (lin e 11 ) less Total Liabilities (line 15). Subtract line 15
from line 11 ......................................................................................
16.
0
Part D: Debt to Asset Ratio
17.
Divide Total Liabilities (line 15) by Total Assets (line 11) ..................
17.
0.00
*1441135019999*
41-135a (7/3/14)