↝

Blank Illinois Boa 4 Form

The Illinois BOA-4 form is a Financial Information Statement designed for individuals to provide a comprehensive overview of their financial situation. This form is typically used in legal and financial contexts, including bankruptcy proceedings or other financial assessments. Completing the BOA-4 requires detailed information about income, assets, and liabilities, ensuring that all relevant financial data is accurately captured.

Outline

The Illinois BOA-4 form serves as a critical tool for individuals seeking to provide detailed financial information to the Illinois Department of Revenue. This form is divided into several sections, each designed to capture essential personal and financial data. In the first section, individuals disclose personal details such as marital status, employment information, and income specifics. This includes average monthly take-home pay and any amounts withheld from paychecks. The second section focuses on financial assets, requiring individuals to list bank accounts, credit lines, real property, insurance policies, and securities. Detailed information about these assets helps to paint a comprehensive picture of an individual’s financial standing. The form also addresses liabilities, including debts and pending financial proceedings, and concludes with an analysis of monthly income and expenses. By gathering this information, the BOA-4 form facilitates a thorough understanding of an individual's financial situation, which is essential for tax assessments and other financial evaluations.

Sample - Illinois Boa 4 Form

Illinois Department of Revenue

BOA-4 Financial Information Statement for Individuals

Section 1: Tell us about yourself and your employment

Part A: Your information

1	Marital status		single	married	separated
	If married, complete your spouse’s information in Part B.
2	Your name ___________________________________________ 11						Filing status	single	married filing jointly
3 Street address ________________________________________								head of household	married filing separately
	____________________________________________________ 12						Average monthly take-home pay $___________________________
	City			State	ZIP	13	Amounts withheld from your paycheck (e.g., savings, bonds,
						13	Amounts withheld from your paycheck (e.g., savings, bonds,
4	Home phone (____)____________________________________						deferred amounts, car payments, etc.) $______________________
5	Social Security number		___ ___ ___- ___ ___- ___ ___ ___ ___				______________________________________________________
6	Unemployed	yes	no If “yes,” how long. _______________ 14				Dates paid _____________________________________________
7	Current or former employer’s name ________________________ 15						Length of employment ____________________________________
8	Address _____________________________________________ 16						Date of birth	___ ___/___ ___/___ ___ ___ ___
	____________________________________________________ 17						Name and address of next of kin (other than spouse)
	City			State	ZIP		Name ________________________________________________
							Name ________________________________________________
9	Work phone (_____)____________________________________						Street address _________________________________________
10	Occupation___________________________________________						______________________________________________________
							City		State	ZIP

Part B: Your spouse’s information

18	Spouse’s name _______________________________________ 25					Work phone(_____)______________________________________
19	Address (if different)____________________________________ 26					Occupation ____________________________________________
	____________________________________________________ 27					Average monthly take-home pay $___________________________
	City		State	ZIP	28	Amounts withheld from your paycheck (e.g., savings, bonds,
					28	Amounts withheld from your paycheck (e.g., savings, bonds,
20	Home phone (if different)(_____)__________________________					deferred amounts, car payments, etc.) $______________________
21	Social Security number		___ ___ ___-___ ___-___ ___ ___ ___			______________________________________________________
22	Unemployed	yes	no If “yes,” how long._______________ 29			Dates paid _____________________________________________
23	Current or former employer’s name ________________________ 30					Length of employment ____________________________________
24	Address _____________________________________________ 31					Date of birth ___ ___/___ ___/___ ___ ___ ___
	____________________________________________________
	City		State	ZIP

Section 2: Complete the following financial information

Note: Attach additional sheets in the same format for any of the following parts if necessary.

Part A: Your bank accounts (include savings and loans, credit unions, IRA and retirement plans, and certificates of deposit)

	A	B	C	D	E
			Type of	Account
	Name of institution	Address	account	number	Balance
32	______________________	_______________________________________	___________	___________	____________
33______________________		_______________________________________	___________	___________	____________
34	______________________	_______________________________________	___________	___________	____________
35	______________________	_______________________________________	___________	___________	____________
36	______________________	_______________________________________	___________	___________	____________
37______________________		_______________________________________	___________	___________	____________
38	Add Lines 32 through 37, Column E, and write the total here and on Part G, Line 56, Column B.			38	____________

BOA-4 (R-4/01)

Page 1 of 4

Part B: Your charge cards or credit lines from your banks, credit unions, and savings and loans

	A	B	C
	Type of account		Current
	or card	Name and address of financial institution	balance
39	_________________	_______________________________________________________________________	___________
40	_________________	_______________________________________________________________________	___________
41	_________________	_______________________________________________________________________	___________
42	_________________	_______________________________________________________________________	___________
43	_________________	_______________________________________________________________________	___________
44	Add Lines 39 through 43, Column C, and write the total here and on Part G, Line 57, Column C.		44 ___________

Part C: Real property you own

	A	B	C	D
	Brief description	How property
	of property	is titled	Physical address	County
45	_____________________________	__________________	_______________________________________	___________
46	_____________________________	__________________	_______________________________________	___________
47	_____________________________	__________________	_______________________________________	___________

Part D: Your life and health insurance policies

	A	B	C	D	E
		Policy		Face	Available
	Insurance company	number	Type	amount	loan value
48	__________________________________________________	___________	___________	___________	___________
49	__________________________________________________	___________	___________	___________	___________
50	Add Lines 48 and 49, Column E, and write the total here and on Part G, Line 60, Column B.				50 ___________

Part E: Your securities (e.g., stocks, bonds, annuities, mutual funds, money market funds, government securities, notes, personal, etc.)

	A	B	C	D	E
	Type			Quantity or
	of security	Location	Owner of record	denomination	Present value
51	_________________	______________________________	_________________________	___________	___________
52	_________________	______________________________	_________________________	___________	___________
53	Add Lines 51 and 52, Column E, and write the total here and on Part G, Line 61, Column B.				53 ___________

Part F: Miscellaneous information

54a Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? b What is the bankruptcy number? ______________________

Yes

c What date was the bankruptcy filed? ___ ___/___ ___/___ ___ ___ ___			If closed, what was the date? ___ ___/___ ___/___ ___ ___ ___
Month	Day	Year	Month	Day	Year

Page 2 of 4

BOA-4 (R-4/01)

Part G: Analyze your assets and liabilities

Note: Write amounts in all unshaded areas that apply

	A	B
		Fair market
	Description	value
55	Cash	___________
56	Total bank accounts
	from Section 2, Part A,
	Line 38	___________

57Total charge cards balance from Section 2, Part B,

Line 44

___________

58Vehicles (model, year)

a ___________________		___________
b ___________________		___________
c ___________________		___________
59	Real property listed
	in Section 2,
	Part C, (Line 45)	___________
	(Line 46)	___________
	(Line 47)	___________
60	Total cash or loan value
	of insurance from
	Section 2, Part D,
	Line 50	___________
61	Total securities from
	Section 2, Part E,
	Line 53	___________
62	Other assets (specify)

Liabilities

balance due

___________

Equity

(Column B minus

Column C)

___________

Monthly payment amount

___________

Pledgee or obligee

___________________

Date of

final

payment

____________

a___________________

b___________________

c___________________

63 Other liabilities not covered above (e.g., judgments, charities, tuition)

a___________________

b___________________

c___________________

64 Federal taxes owed

65 State taxes owed a Illinois individual

income tax

b Illinois business income tax

c Other state taxes

66Total

___________

___________________

____________

BOA-4 (R-4/01)

Page 3 of 4

Part H: Analyze your monthly income and expenses

Income

	A	B	C
	Source	Gross	Net
67	Your wages or salary	___________________	___________________
68	Your spouse’s
	wages or salary	___________________	___________________
69	Interest or dividends	___________________	___________________
70	Business income	___________________	___________________
71	Rental income	___________________	___________________
72	Your pension	___________________	___________________
73	Your spouse’s pension	___________________	___________________
74	Child support	___________________	___________________
75	Alimony	___________________	___________________

76Other (specify)

________________ ___________________ ___________________

________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
77 Add Lines 67 through 76, Column C.
This amount is your total net income.		____________________

Necessary monthly living expenses

A	B
Expense	Amount

78Rent (not included

	in Part G, Line 59)			___________________
79	Groceries
	(number of people____)			___________________
80	Installment pmts. from
	Part G, Line 66, Col. E			___________________
81	Utilities	a	gas	___________________
		b	water	___________________
		c	electric	___________________
		d	telephone	___________________
82	Transportation			___________________
83	Insurance	a	life	___________________
	(monthly	b	health	___________________
	premiums) c		home	___________________
		d	car	___________________

84Medical (not covered

	in Line 83b above)	___________________
85	Estimated tax payments	___________________
86	Court-ordered payments	___________________

87Other (specify)

__________________ ___________________

88Add Lines 78 through 87. This amount is your

total expenses.

___________________

89 Subtract Line 88 from Line 77. This amount is your net income after expenses.

89 ___________________

Part I: Complete any additional asset or income information

90Write any additional information you have about your assets or income that was not included in any of the preceding parts. Be sure to include a statement regarding the prospect of any increase in the value of your assets or your present income.

_____________________________________________________________________________________________________________

Section 3: Sign below

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

______________________________________________/___/_____ ______________________________________________/___/_____

Petitioner’s signature (not representative)

Date

Spouse’s signature

Date

Page 4 of 4

This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide information
could result in this form not being processed. This form has been approved by the Forms Management Center.	IL-492-3683	BOA-4 (R-4/01)

Click for PDF

Form Information

Fact Name	Details
Form Purpose	The Illinois BOA-4 form is a Financial Information Statement for individuals, primarily used to assess financial status for tax purposes.
Governing Law	This form is authorized under the Illinois Income Tax Act, which mandates the disclosure of financial information.
Sections Included	The form consists of three main sections: personal information, financial details, and a signature section confirming accuracy under penalty of perjury.
Marital Status	Individuals must indicate their marital status and provide relevant information about their spouse if applicable.
Financial Disclosure	Applicants are required to disclose various financial details, including income, bank accounts, and liabilities.
Submission Requirements	Additional sheets may be attached if necessary, ensuring all required financial information is provided for accurate assessment.

Detailed Guide for Filling Out Illinois Boa 4

Completing the Illinois BOA-4 form requires careful attention to detail. After filling out the form, you will need to submit it as part of your financial disclosure process. Ensure that all sections are filled out accurately to avoid delays in processing.

Begin with Section 1, Part A. Indicate your marital status (single, married, or separated).
Fill in your name, street address, city, state, and ZIP code.
Provide your home and work phone numbers.
Enter your Social Security number and indicate if you are unemployed, including the duration of unemployment if applicable.
List your current or former employer's name and address, and provide your occupation.
Complete your average monthly take-home pay and amounts withheld from your paycheck.
In Part B, if married, fill out your spouse’s information, including their name, address, and employment details.
In Section 2, Part A, list your bank accounts, including the type of account, institution name, address, account number, and balance.
In Part B, provide details of your charge cards or credit lines, including the current balance.
In Part C, describe any real property you own, including how it is titled and its physical address.
In Part D, list your life and health insurance policies, including policy numbers and face amounts.
In Part E, detail your securities, including type, quantity, and present value.
In Part F, answer questions about any pending foreclosure, bankruptcy, or other legal proceedings.
In Part G, analyze your assets and liabilities. Fill in fair market values for cash, bank accounts, vehicles, and other assets.
In Part H, analyze your monthly income and expenses. List sources of income and necessary living expenses.
In Part I, provide any additional asset or income information not previously covered.
Finally, sign and date the form under penalties of perjury, confirming that all information is true and complete.

Obtain Answers on Illinois Boa 4

What is the Illinois BOA-4 form?

The Illinois BOA-4 form is a Financial Information Statement for Individuals. It is used by the Illinois Department of Revenue to collect financial information from individuals. This information is necessary for various purposes, including tax assessments and eligibility for certain programs.
Who needs to fill out the BOA-4 form?

Individuals who are required to report their financial status to the Illinois Department of Revenue need to complete this form. This may include those applying for tax relief, those involved in bankruptcy proceedings, or anyone whose financial situation needs to be assessed by the state.
What information is required on the BOA-4 form?

The form requires personal details such as your name, marital status, and employment information. Additionally, you must provide financial information, including:
- Bank account balances
- Credit card balances
- Real estate ownership
- Insurance policies
- Assets and liabilities
It’s essential to provide accurate and complete information to avoid delays in processing.
How do I submit the BOA-4 form?

You can submit the BOA-4 form by mailing it to the appropriate address provided by the Illinois Department of Revenue. Ensure you keep a copy for your records. If you are unsure where to send it, check the department's website or contact them directly for guidance.
What happens if I do not fill out the BOA-4 form?

If you fail to complete and submit the BOA-4 form when required, it may result in penalties or delays in processing your tax-related matters. The Illinois Department of Revenue may not be able to assess your situation properly, which could lead to unfavorable outcomes.
Can I get help filling out the BOA-4 form?

Yes, assistance is available. You can seek help from tax professionals, financial advisors, or community organizations that provide support with tax forms. Additionally, the Illinois Department of Revenue may offer resources or guidance to help you complete the form accurately.

Common mistakes

Filling out the Illinois BOA-4 form can be straightforward, but many people make common mistakes that can lead to delays or complications. One frequent error is not providing complete information in the marital status section. If you are married, it’s essential to fill out your spouse’s information in Part B. Missing this detail can cause the form to be returned or rejected, which can be frustrating.

Another common mistake is neglecting to include accurate financial details. When listing your bank accounts, for instance, be sure to provide the correct account numbers and balances. Incomplete or incorrect entries can lead to discrepancies that may require additional follow-up. It’s important to double-check this information before submitting the form.

People often overlook the importance of their income details as well. When indicating your average monthly take-home pay, make sure to include all sources of income. This includes wages, rental income, and any other earnings. Failing to report all income can misrepresent your financial situation and may lead to issues later.

Lastly, many individuals forget to sign the form. Without a signature, the document is not valid. Remember to sign and date the form at the bottom. This step is crucial to ensure that your submission is processed without any hitches. Taking the time to review each section carefully can save you from these common pitfalls.

Documents used along the form

The Illinois BOA-4 form is a crucial document for individuals providing detailed financial information. Alongside this form, several other documents are commonly used to support the financial disclosures made. Each of these documents serves a specific purpose and helps create a comprehensive financial picture.

Illinois Income Tax Return (Form IL-1040): This form is used to report an individual's income to the state of Illinois. It includes information about wages, interest, dividends, and other sources of income, which helps verify the financial data provided in the BOA-4.
Proof of Income Documentation: This includes pay stubs, bank statements, or tax returns. These documents provide evidence of income and help confirm the amounts listed on the BOA-4 form.
Asset Verification Documents: This category includes titles, deeds, and account statements for real estate and financial accounts. These documents help establish ownership and current value of assets reported in the BOA-4.
Debt Statements: These are documents from creditors detailing outstanding debts, such as credit card statements or loan agreements. They support the liabilities section of the BOA-4 by providing a clear picture of what is owed.
Bank Statements: Recent bank statements can help verify account balances listed in the BOA-4. They provide insight into an individual's financial activity and stability.
Insurance Policy Documents: These documents outline the details of life and health insurance policies. They support the financial information provided in the BOA-4, particularly in the section regarding insurance assets.
Real Estate Appraisal Reports: If applicable, these reports provide a professional assessment of property value. They help validate the real property values listed in the BOA-4.
Monthly Expense Documentation: This includes bills and statements that outline regular monthly expenses. They help clarify the financial obligations that impact net income calculations on the BOA-4.
Bankruptcy Documents: If an individual has filed for bankruptcy, related documents are necessary to provide context to the financial situation. These documents can include the bankruptcy petition and discharge papers.

Using these documents in conjunction with the Illinois BOA-4 form helps create a clear and accurate financial representation. This ensures that all relevant information is available for review, aiding in the decision-making process regarding financial matters.

Similar forms

Form 1040 (U.S. Individual Income Tax Return): Like the Illinois BOA-4 form, the Form 1040 requires individuals to provide personal information, including income sources and filing status. Both forms aim to assess an individual's financial situation, although the Form 1040 is primarily for federal tax purposes.
Schedule A (Itemized Deductions): This document is similar in that it requires detailed financial information. Schedule A allows taxpayers to itemize deductions, much like the BOA-4 collects information on various assets and liabilities to provide a comprehensive view of an individual's financial standing.
Form W-2 (Wage and Tax Statement): The W-2 form reports an employee's annual wages and the taxes withheld from their paycheck. Both the W-2 and the BOA-4 require accurate reporting of income, though the W-2 focuses on employment income while the BOA-4 encompasses a broader range of financial information.
Form 1065 (U.S. Return of Partnership Income): This form is used by partnerships to report income, deductions, and other information. Like the BOA-4, it demands detailed financial disclosures, but it focuses on partnership income rather than individual finances.
Bankruptcy Schedules (B and C): In bankruptcy proceedings, these schedules require individuals to list their assets and liabilities, akin to the BOA-4. Both documents serve to provide a complete picture of an individual's financial situation, but the bankruptcy schedules are used in a legal context to assess eligibility for bankruptcy relief.

Dos and Don'ts

When filling out the Illinois BOA-4 form, it’s crucial to ensure accuracy and completeness. Here’s a list of dos and don’ts to guide you through the process:

Do read the instructions carefully before starting.
Do provide accurate and up-to-date information about your financial status.
Do double-check all entries for spelling and numerical accuracy.
Do include your spouse’s information if you are married.
Do attach additional sheets if you need more space for financial information.
Don’t leave any required fields blank; fill in all necessary information.
Don’t provide false information or omit details that could affect your application.
Don’t forget to sign and date the form before submitting it.
Don’t submit the form without reviewing it one last time for errors.

Misconceptions

Misconception 1: The BOA-4 form is only for individuals with high incomes.

This is incorrect. The BOA-4 form is designed for all individuals, regardless of income level. It helps to provide a comprehensive view of financial status, which can be necessary for various situations, including tax assessments or financial aid applications.

Misconception 2: You must fill out the entire form in one sitting.

Many people believe they need to complete the BOA-4 form in one go. However, you can take your time. If you need to gather additional information or documentation, it’s perfectly acceptable to pause and return to it later. Just ensure that you complete it before the deadline.

Misconception 3: The form is only for married couples.

This misconception overlooks the fact that the BOA-4 form is applicable to single individuals as well. Whether you are single, married, or separated, you can use this form to report your financial information accurately.

Misconception 4: You don't need to provide information about your spouse if you're separated.

Even if you are separated, the BOA-4 form requires you to include your spouse's information in certain sections. This is crucial for accurately assessing your overall financial situation and obligations. Omitting this information could lead to complications in processing your form.

Key takeaways

Filling out the Illinois BOA-4 form can seem daunting, but understanding its key components can simplify the process. Here are some important takeaways to keep in mind:

Personal Information: Ensure that all personal details, such as your name, address, and social security number, are accurately filled out in Part A. This information is crucial for identification and processing.
Employment Status: Clearly indicate your employment status and provide information about your employer. This includes your occupation, length of employment, and average monthly take-home pay.
Spousal Information: If married, it is essential to complete Part B with your spouse's information. This includes their income and employment details, which are vital for a comprehensive financial picture.
Financial Assets: In Section 2, be thorough when listing your financial accounts, including bank accounts, credit cards, and real property. Accurate reporting of balances and values will help in assessing your financial situation.
Monthly Income and Expenses: Part H requires a detailed breakdown of your income and expenses. This section is critical for understanding your financial health and determining your ability to meet obligations.
Signature and Verification: Finally, remember to sign and date the form. By doing so, you affirm that the information provided is true and complete, which is essential for legal and processing purposes.

By keeping these points in mind, individuals can navigate the Illinois BOA-4 form more effectively and ensure that they provide all necessary information for accurate processing.