Fillable Form Ia 6251b - Balance Sheet/statement Of Net Worth

Form Ia 6251b - Balance Sheet/statement Of Net Worth - 1998

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I OWA

IA 6251B 1998

d e p a r t m e n t o f R eve n u e a n d F i n a n c e

Balance Sheet/Statement of Net Worth

As of ___________ ,19 ___

NAME(s)

Social Security Number

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 less Total Liabilities (line 11 less line 15) .............................. 16. _______________________

PART D: DEBT TO ASSET RATIO

17. Divide Total Liabilities (line 15) by Total Assets (line 11) .......................... 17. _______________________

41-135a (6/98)

Form Ia 6251b - Balance Sheet/statement Of Net Worth - 1998

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