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Official Illinois Boa 4 Form in PDF

The Illinois BOA-4 form is a Financial Information Statement designed for individuals to report their financial status to the Illinois Department of Revenue. This form collects essential information about personal and financial details, including income, assets, and liabilities. Proper completion of the BOA-4 is crucial for individuals seeking assistance or making financial disclosures in Illinois.

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The Illinois BOA-4 form serves as a crucial tool for individuals seeking to provide detailed financial information to the Illinois Department of Revenue. This comprehensive form collects essential data about personal and financial circumstances, ensuring that the state has a clear picture of an individual's financial status. The form is divided into several sections, beginning with personal details such as marital status, employment information, and contact details. It prompts individuals to disclose their income, including average monthly take-home pay and any amounts withheld from paychecks. Furthermore, the BOA-4 requires a thorough account of bank assets, credit lines, real property ownership, and insurance policies. Individuals must also provide information about their securities and any pending legal proceedings, such as bankruptcy. In the final sections, the form asks for an analysis of assets and liabilities, alongside a breakdown of monthly income and expenses. Completing this form accurately is vital, as it directly impacts the assessment of financial obligations and benefits under Illinois tax law.

Frequently Asked Questions

What is the Illinois BOA-4 form?

The Illinois BOA-4 form, also known as the Financial Information Statement for Individuals, is a document used to provide detailed financial information to the Illinois Department of Revenue. It helps the department assess an individual's financial situation, particularly in cases related to tax obligations, financial assistance, or other legal matters.

Who needs to fill out the BOA-4 form?

Individuals who are required to disclose their financial information for tax purposes, financial aid, or court-related matters typically need to complete the BOA-4 form. This includes those who are undergoing bankruptcy proceedings, seeking financial assistance, or responding to inquiries from the Illinois Department of Revenue.

What information is required on the BOA-4 form?

The BOA-4 form requires personal information such as your name, address, marital status, and employment details. Additionally, it asks for comprehensive financial details, including bank account balances, credit card debts, real property ownership, insurance policies, and other assets and liabilities. This thorough collection of data helps create a complete picture of your financial situation.

How do I report my income on the BOA-4 form?

Income reporting on the BOA-4 form involves listing all sources of income, including wages, business earnings, rental income, pensions, and any other relevant financial inflows. You will need to provide both gross and net income figures, ensuring that all information is accurate and up-to-date to reflect your current financial status.

Can I attach additional information to the BOA-4 form?

Yes, if you find that there is not enough space on the form to provide all necessary information, you can attach additional sheets in the same format. This is particularly useful for detailing multiple bank accounts, properties, or other financial assets that require more explanation.

What happens if I do not fill out the BOA-4 form completely?

Failure to provide complete information on the BOA-4 form may result in processing delays or complications with your case. The Illinois Department of Revenue requires full disclosure to accurately assess your financial situation, so it’s essential to ensure all sections are filled out thoroughly.

How do I submit the BOA-4 form?

The completed BOA-4 form should be submitted according to the instructions provided by the Illinois Department of Revenue. Typically, this involves mailing the form to the appropriate address or submitting it online if that option is available. Be sure to check for any specific submission guidelines to avoid any issues.

Is there a deadline for submitting the BOA-4 form?

Yes, there are usually deadlines associated with the submission of the BOA-4 form, particularly if it is tied to a legal or financial proceeding. It’s crucial to be aware of these deadlines to ensure compliance and avoid any penalties or complications in your case.

Form Specifications

Fact Name	Description
Form Purpose	The Illinois BOA-4 form is used to collect financial information from individuals for tax purposes.
Governing Law	This form is authorized under the Illinois Income Tax Act, which governs the collection of state income taxes.
Sections Included	The form consists of multiple sections, including personal information, financial details, and asset analysis.
Marital Status Options	Individuals must indicate their marital status, with options including single, married, separated, and others.
Financial Disclosure	Users are required to disclose various financial details, such as income, bank accounts, and liabilities.
Signature Requirement	Signatures from both the petitioner and spouse (if applicable) are required, affirming the accuracy of the information provided.

Common mistakes

Incorrect Marital Status: Selecting the wrong marital status can lead to significant discrepancies in the financial information provided. Ensure you accurately mark whether you are single, married, or separated.
Missing Spouse Information: If married, failing to complete your spouse’s information in Part B can result in an incomplete application. Both parties' details are essential for accurate assessment.
Inaccurate Income Reporting: Underreporting or overreporting your average monthly take-home pay can misrepresent your financial situation. Double-check all figures to ensure accuracy.
Neglecting to Include All Bank Accounts: Omitting bank accounts, loans, or retirement plans can lead to an incomplete financial picture. List all relevant accounts in Part A of Section 2.
Errors in Property Information: Providing incorrect details about real property ownership can cause issues. Ensure that the description, title, and physical address are accurate.
Inaccurate Reporting of Liabilities: Not fully disclosing all debts and obligations can result in complications. List every liability, including loans and judgments, in Part G.
Missing Signatures: Failing to sign the form can lead to immediate rejection. Both the petitioner and spouse must sign and date the document.
Ignoring Additional Information Section: Not providing extra details about assets or income that could impact your financial status may hinder the review process. Use Part I to include relevant information.

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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)

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)

Dos and Don'ts

When filling out the Illinois BOA-4 form, it is important to follow specific guidelines to ensure accuracy and completeness. Below is a list of things to do and avoid during the process:

Do provide accurate personal information, including your name and Social Security number.
Do double-check your marital status and ensure it matches your filing status.
Do include all sources of income and any relevant financial details.
Do attach additional sheets if necessary for any section that requires more space.
Do sign and date the form to validate your submission.
Don't leave any required fields blank; incomplete information may delay processing.
Don't provide false information or omit details, as this could lead to penalties.

Documents used along the form

The Illinois BOA-4 form is a crucial document for individuals needing to provide financial information to the Illinois Department of Revenue. Alongside this form, several other documents may be necessary to support the financial disclosures made. Below is a list of commonly used forms and documents that complement the Illinois BOA-4.

Illinois Individual Income Tax Return (IL-1040): This form is used to report income earned by individuals in Illinois. It details income, deductions, and credits, and determines the amount of tax owed or refund due.
W-2 Form: Employers provide this form to employees, summarizing annual wages and the taxes withheld. It is essential for verifying income reported on the BOA-4.
1099 Form: This form reports various types of income received throughout the year, such as freelance work or interest payments. It helps document additional income sources not covered by a W-2.
Bank Statements: Recent bank statements provide proof of financial status, showing account balances and transaction history. They support the information reported in the BOA-4 regarding bank accounts.
Pay Stubs: These documents detail an employee's earnings and deductions for each pay period. They help confirm the average monthly take-home pay reported on the BOA-4.
Proof of Assets: Documents such as property deeds, vehicle titles, or investment statements help substantiate the value of assets listed in the BOA-4.
Debt Statements: These include credit card statements or loan documents that outline outstanding balances and payment terms, necessary for accurately reporting liabilities.
California Marital Separation Agreement: This legal agreement outlines separation terms for spouses in California, addressing property division and custody issues. For a fillable version, visit California Templates.
Bankruptcy Documents: If applicable, these documents provide information about ongoing bankruptcy proceedings, including filing dates and case numbers, which are important for full financial disclosure.

Gathering these forms and documents will ensure a comprehensive submission alongside the Illinois BOA-4, facilitating a smoother review process by the Department of Revenue. Proper documentation is key to accurately reflecting financial circumstances.

Misconceptions

Misconceptions about the Illinois BOA-4 form can lead to confusion and potential errors in submission. Here are four common misconceptions:

The BOA-4 form is only for individuals with high income. Many believe that only those with significant financial assets need to complete this form. In reality, the BOA-4 is required for anyone seeking financial assistance or making claims related to financial hardship, regardless of income level.
All sections of the BOA-4 must be filled out completely. Some individuals think that every section is mandatory. While it is essential to provide accurate information, if a section does not apply to you, it is acceptable to leave it blank or indicate "not applicable." Be sure to follow the instructions provided with the form.
Providing estimates is sufficient for financial information. Many people assume that rough estimates of income and assets are acceptable. However, accurate figures are crucial for the processing of the form. Providing incorrect or estimated amounts can lead to delays or denials of assistance.
The BOA-4 form is only relevant during tax season. Some individuals think this form is only necessary when filing taxes. In fact, the BOA-4 can be required at any time when applying for financial aid, loans, or other forms of assistance. It is important to be prepared with this information year-round.

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