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Blank Illinois Boa 4 PDF Form

The Illinois BOA-4 form is a Financial Information Statement designed for individuals to provide essential details about their financial status. This form assists the Illinois Department of Revenue in evaluating an individual's financial situation, including income, expenses, and assets. Completing the BOA-4 accurately is crucial for ensuring that your financial information is properly assessed; click the button below to start filling out the form.

Article Guide

The Illinois BOA-4 form is a comprehensive financial information statement designed for individuals to provide detailed insight into their financial situation. This form is particularly important for those navigating specific financial processes, such as tax filings or applications for financial assistance. It consists of several sections that require personal and employment information, including marital status, income, and employment history. Additionally, individuals must disclose their financial assets, such as bank accounts, real property, and insurance policies, as well as liabilities like debts and taxes owed. The BOA-4 form also assesses monthly income and expenses, allowing for a clearer picture of an individual’s financial health. By collecting this information, the form helps ensure that the appropriate financial decisions can be made based on accurate data. Completing the BOA-4 form accurately is crucial, as it not only affects eligibility for various programs but also ensures compliance with state regulations.

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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)

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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

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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)

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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

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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)

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Form Specifications

Fact Name	Description
Form Title	Illinois Department of Revenue BOA-4 Financial Information Statement for Individuals
Governing Law	This form is authorized under the Illinois Income Tax Act.
Purpose	The BOA-4 form collects financial information from individuals for tax assessment purposes.
Marital Status Options	Individuals can select from single, married, separated, or head of household.
Employment Information	Part A requires details about the individual's current or former employer and their occupation.
Spousal Information	If married, the form requests information about the spouse in Part B.
Financial Disclosure	Sections 2 through 6 detail bank accounts, credit lines, real property, insurance policies, and securities.
Liabilities and Assets	Part G analyzes the individual's assets and liabilities to determine financial standing.
Monthly Income and Expenses	Part H requires a breakdown of monthly income sources and necessary living expenses.
Signature Requirement	The form must be signed under penalties of perjury, affirming the truthfulness of the information provided.

Illinois Boa 4: Usage Guidelines

Filling out the Illinois BOA-4 form is an important step in providing your financial information to the state. This document requires careful attention to detail, as it asks for various aspects of your financial situation. To ensure accuracy and completeness, follow the steps outlined below.

Start with Section 1, Part A. Indicate your marital status by selecting single, married, or separated.
Fill in your name, street address, city, state, and ZIP code.
Provide your home phone number and Social Security number.
Answer whether you are currently unemployed and, if so, indicate how long you have been unemployed.
Enter the name and address of your current or former employer, along with your occupation and work phone number.
Provide your average monthly take-home pay and any amounts withheld from your paycheck.
Complete Part B by filling in your spouse’s information, including their name, address, phone numbers, Social Security number, employment details, and financial information.
In Section 2, Part A, list all your bank accounts. For each account, provide the type, name of the institution, address, account number, and balance.
In Part B, list your charge cards or credit lines, including the current balance for each account.
In Part C, describe any real property you own, including how it is titled, the physical address, and the county.
In Part D, provide details about your life and health insurance policies, including policy numbers, face amounts, and available loan values.
In Part E, list your securities, detailing the type, quantity, location, owner of record, and present value.
In Part F, answer questions about any pending legal proceedings such as foreclosure or bankruptcy.
Move to Part G and analyze your assets and liabilities. Fill in the fair market value of your assets and the balance due for your liabilities.
In Part H, analyze your monthly income and expenses. List all sources of income and necessary living expenses, then calculate your total expenses and net income after expenses.
Complete Part I by writing any additional information about your assets or income that was not covered in previous sections.
Finally, sign and date the form in Section 3, confirming that the information is true and correct.

Your Questions, Answered

What is the purpose of the Illinois BOA-4 form?

The Illinois BOA-4 form, officially known as the Financial Information Statement for Individuals, is designed to collect detailed financial information from individuals. This form helps the Illinois Department of Revenue assess a person's financial situation, particularly in relation to state tax obligations. It gathers information about income, assets, liabilities, and other financial details that may affect tax filings or eligibility for certain tax relief programs.

Who needs to fill out the BOA-4 form?

Individuals who are seeking assistance with their state taxes or who are involved in financial proceedings may need to complete the BOA-4 form. This includes those who may be applying for a payment plan, requesting a tax waiver, or undergoing a financial review for other tax-related matters. If you are unsure whether you need to fill out this form, consulting with a tax professional can provide clarity.

What information is required in the BOA-4 form?

The BOA-4 form requires a variety of personal and financial information. This includes your marital status, employment details, income sources, bank account balances, credit card information, real property ownership, and insurance policies. Additionally, you will need to disclose any liabilities, such as loans or debts, and provide a comprehensive overview of your monthly income and expenses. Accurate and complete information is crucial for the form to be processed correctly.

How should I submit the BOA-4 form once completed?

Once you have filled out the BOA-4 form, you should submit it to the appropriate office of the Illinois Department of Revenue. Be sure to check for any specific submission guidelines, as these may vary. It is often recommended to keep a copy of the completed form for your records. If you are submitting it by mail, consider using a trackable mailing option to ensure it reaches its destination safely.

What happens if I make a mistake on the BOA-4 form?

If you realize that you have made a mistake on the BOA-4 form after submission, it is important to address it promptly. You may need to submit a corrected version of the form along with an explanation of the error. Contacting the Illinois Department of Revenue directly can provide guidance on the best course of action. Remember, providing accurate information is essential to avoid potential complications with your tax situation.

Common mistakes

Incorrect Marital Status: Many people mistakenly select the wrong marital status. It’s crucial to choose the correct option—single, married, or separated—because it affects your filing status and potential tax benefits.
Missing or Incorrect Social Security Number: Some individuals forget to include their Social Security number or enter it incorrectly. This can lead to delays in processing your form, as the number is essential for identification purposes.
Inaccurate Financial Information: Failing to provide accurate details about income, expenses, or assets can create significant issues. Double-check the amounts you report, especially regarding monthly take-home pay and amounts withheld from your paycheck.
Neglecting to Sign the Form: A common oversight is forgetting to sign the form. Without a signature, the submission is incomplete, and the form cannot be processed. Ensure both you and your spouse sign if applicable.

Documents used along the form

The Illinois BOA-4 form is a Financial Information Statement for Individuals, which collects detailed financial data from individuals, often for tax or legal purposes. Several other forms and documents are frequently used in conjunction with the BOA-4 to provide a comprehensive overview of an individual's financial situation. Below is a list of these related documents, along with brief descriptions of each.

Illinois Form IL-1040: This is the individual income tax return form for residents of Illinois. It is used to report income, claim tax credits, and determine the amount of tax owed or refund due.
Illinois Schedule CR: This form is used to claim a credit for taxes paid to other states. Taxpayers who have income from outside Illinois may need to file this form to avoid double taxation.
Illinois Schedule A: This document allows taxpayers to itemize their deductions instead of taking the standard deduction. It includes expenses such as mortgage interest, property taxes, and charitable contributions.
Bank Statements: These documents provide a detailed record of an individual's banking transactions over a specific period. They are often used to verify income and expenses reported on financial forms.
Pay Stubs: Pay stubs are issued by employers and detail an employee's earnings and deductions for a specific pay period. They help confirm monthly income and can be crucial for financial assessments.

Each of these documents plays a vital role in providing a complete picture of an individual's financial status, which is essential for accurate reporting and compliance with tax obligations. Properly compiling and submitting these forms can help ensure a smooth process when dealing with financial matters in Illinois.

Similar forms

The Illinois BOA-4 form is a financial information statement that helps individuals provide a detailed overview of their financial situation. It shares similarities with several other documents used for financial assessment. Here are four documents that are similar to the Illinois BOA-4 form:

Bankruptcy Petition: Like the BOA-4, a bankruptcy petition requires individuals to disclose their financial information, including assets, liabilities, income, and expenses. Both documents aim to provide a clear picture of a person's financial status.
Financial Disclosure Statement: This document is often used in divorce proceedings. It collects information about income, expenses, assets, and debts, similar to the BOA-4. Both forms help in assessing financial obligations and entitlements.
Loan Application: When applying for a loan, individuals must provide detailed financial information, including income and assets. The structure of a loan application resembles the BOA-4, as both require similar financial disclosures to evaluate eligibility.
Tax Return: A tax return requires individuals to report their income and financial situation to the government. It shares common elements with the BOA-4, such as detailing income sources and deductions, making both essential for understanding financial health.

Dos and Don'ts

When filling out the Illinois BOA-4 form, it’s important to be thorough and accurate. Here’s a list of things you should and shouldn’t do:

Do read the entire form carefully before starting.
Do provide your current and accurate personal information.
Do include all sources of income, even if they seem minor.
Do double-check your calculations for accuracy.
Do sign and date the form before submission.
Don’t leave any sections blank; fill in all applicable fields.
Don’t provide false information or omit details.
Don’t rush through the form; take your time to ensure accuracy.
Don’t forget to attach any necessary additional sheets if required.
Don’t submit the form without making copies for your records.

Misconceptions

1. The BOA-4 form is only for married individuals. This form can be completed by single, married, or separated individuals. It accommodates various marital statuses.

2. You must provide your spouse's information even if you are filing separately. Only include your spouse's information if you are married and filing jointly. If filing separately, you can skip that section.

3. The form is only for people with significant assets. The BOA-4 form is for anyone needing to report their financial situation, regardless of asset size.

4. You cannot attach additional sheets. If you need more space, you can attach additional sheets in the same format as the form. Ensure all information remains clear and organized.

5. All sections of the form must be completed. Only fill out sections that apply to your situation. If a section does not apply, you can leave it blank.

6. You can use outdated versions of the form. Always use the most current version of the BOA-4 form to ensure compliance with regulations.

7. The form is not necessary if you have no income. Even if you have no income, you may still need to complete the form to provide a complete picture of your financial situation.

8. You do not need to sign the form. The form must be signed by both the petitioner and the spouse (if applicable) to validate the information provided.

9. Financial information is optional. Providing accurate financial information is mandatory. Failure to do so may result in processing delays.

10. The form is only used for tax purposes. The BOA-4 form can be used in various legal and financial contexts, not just for tax filings.

Key takeaways

Understand the Purpose: The Illinois BOA-4 form is designed to collect financial information about individuals and their spouses. This information can be crucial for tax assessments and other financial evaluations.
Complete All Sections: Ensure that you fill out every section of the form, including your personal information, your spouse's details, and your financial assets and liabilities. Missing information can delay processing.
Be Accurate: Double-check all numbers and details before submitting. Inaccurate information can lead to complications or even legal issues.
Include Supporting Documents: If necessary, attach additional sheets that follow the same format for any part of the form that requires more space.
Provide Current Financial Information: When listing bank accounts, credit cards, and other assets, make sure the information is up-to-date. This reflects your current financial situation.
Understand Your Marital Status: Your marital status affects how you fill out the form. If married, include your spouse's financial information, and select the correct filing status.
Review Before Submission: Take a moment to review the entire form. Look for any errors or omissions that could impact your filing.
Sign and Date: Don’t forget to sign and date the form. An unsigned form may not be processed.
Know the Consequences: Understand that failing to provide accurate information can lead to penalties or your form not being processed. Transparency is key.