Iowa Department of Revenue
https://tax.iowa.gov
IA 6251B
Balance Sheet/Statement of Net Worth
This form can be used for all tax years.
Net Worth Calculation Date
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 (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
41-135a (09/16/15)