Form EG-13-I "Financial and Other Information Statement for Individuals" - Illinois

What Is Form EG-13-I?

This is a legal form that was released by the Illinois Department of Revenue - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2012;
  • The latest edition provided by the Illinois Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form EG-13-I by clicking the link below or browse more documents and templates provided by the Illinois Department of Revenue.

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Download Form EG-13-I "Financial and Other Information Statement for Individuals" - Illinois

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Illinois Department of Revenue
EG-13-I
Financial and Other Information Statement for Individuals
Note:
We may require support for amounts shown on this form.
Step 1: Tell us about yourself and your employment
Debtor’s information
Employment information
1
7
Your name ___________________________________________
Employer’s name _____________________________________
Street address ________________________________________
Address ____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
2
8
Email address ________________________________________
Work phone (_____)________________
9
3 Home phone (_____)________________
Length of employment _________________________________
4
Date of birth ___ ___/___ ___/___ ___ ___ ___
5
Social Security number
___ ___ ___ - ___ ___ - ___ ___ ___ ___
6
Number of dependents in household _______________________
Step 2: Tell us about other income and property.
Attach an additional sheet, if necessary.
10
Real property (brief description and location) ________________ _________________________________________________________
______________________________________________________ _______________________________________________________
______________________________________________________ _______________________________________________________
11
List the name and address of the banks where you have accounts.
Name_______________________________________________
Name_______________________________________________
Address _____________________________________________
Address _____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
Name_______________________________________________
Name_______________________________________________
Address _____________________________________________
Address _____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
12
Vehicle license number ____
_________________________________________________________________________________________________
Vehicle description _____________________________________________________________________________________________
Step 3: Tell us if bankruptcy is pending
13
Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? ____yes ____no
14
Bankruptcy number ____________________________________
15
Date filed ___ ___/___ ____/___ ___ ___ ___
Continue to next
page....
EG-13-I front (R-5/12)
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
EG-13-I
Financial and Other Information Statement for Individuals
Note:
We may require support for amounts shown on this form.
Step 1: Tell us about yourself and your employment
Debtor’s information
Employment information
1
7
Your name ___________________________________________
Employer’s name _____________________________________
Street address ________________________________________
Address ____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
2
8
Email address ________________________________________
Work phone (_____)________________
9
3 Home phone (_____)________________
Length of employment _________________________________
4
Date of birth ___ ___/___ ___/___ ___ ___ ___
5
Social Security number
___ ___ ___ - ___ ___ - ___ ___ ___ ___
6
Number of dependents in household _______________________
Step 2: Tell us about other income and property.
Attach an additional sheet, if necessary.
10
Real property (brief description and location) ________________ _________________________________________________________
______________________________________________________ _______________________________________________________
______________________________________________________ _______________________________________________________
11
List the name and address of the banks where you have accounts.
Name_______________________________________________
Name_______________________________________________
Address _____________________________________________
Address _____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
Name_______________________________________________
Name_______________________________________________
Address _____________________________________________
Address _____________________________________________
____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
12
Vehicle license number ____
_________________________________________________________________________________________________
Vehicle description _____________________________________________________________________________________________
Step 3: Tell us if bankruptcy is pending
13
Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? ____yes ____no
14
Bankruptcy number ____________________________________
15
Date filed ___ ___/___ ____/___ ___ ___ ___
Continue to next
page....
EG-13-I front (R-5/12)
Step 4: Complete the following statement of assets and liabilities
A
B
C
D
E
F
G
Monthly
Date of
Date of
Amount of
Present
Liabilities
payment
first
final
equity or asset
Description
value
Balance due
amount
Pledgee or obligee
payment
payment
(Col. A minus B)
16
Bank accounts
_________
_________
_________
_________
__________________
________
________
17
_________
_________
_________
_________
__________________
________
________
Household furniture
18
_________
_________
_________
_________
__________________
________
________
Home mortgage
19
Rental properties
_________
_________
_________
_________
__________________
________
________
20
_________
_________
_________
_________
__________________
________
________
Real property
21
Vehicles (model/year)
a __________________
_________
_________
_________
_________
__________________
________
________
b __________________
_________
_________
_________
_________
__________________
________
________
22
Other assets (describe)
a __________________
_________
_________
_________
_________
__________________
________
________
b __________________
_________
_________
_________
_________
__________________
________
________
23
Federal taxes outstanding
_________
_________
_________
_________
__________________
________
________
24
_________
_________
_________
_________
__________________
________
________
State taxes outstanding
25
_________
_________
_________
_________
__________________
________
________
Accounts/notes payable
26
Charge cards
a __________________
_________
_________
_________
_________
__________________
________
________
b __________________
_________
_________
_________
_________
__________________
________
________
27
Other (include judgments)
a __________________
_________
_________
_________
_________
__________________
________
________
b __________________
_________
_________
_________
_________
__________________
________
________
28
_________
_________
_________
_________
Total
Step 5: Complete the following monthly income and expense analysis
Household monthly income
Monthly expenses
Source
Net
Expense
Amount
29
35
Your take home pay
___________________
Rent (if no home mortgage in Step 4) ___________________
30
36
Your spouse’s take home pay
___________________
Groceries
___________________
31
37
Pensions
___________________
Monthly payments (from Line 28)
___________________
32
38
Rental income
___________________
Utilities
___________________
33
39
Other (specify)
Auto expenses (i.e., insurance, gas)
___________________
40
________________
___________________
Child support paid
___________________
41
________________
___________________
Other (specify)
________________
___________________
___________________
___________________
________________
___________________
___________________
___________________
________________
___________________
___________________
___________________
34
42
Add Lines 29 through 33.
Add Lines 35 through 41.
This amount is your total net income.
____________________
This amount is your total expenses.
___________________
43
43
Subtract Line 42 from Line 34. This amount is your monthly net income after expenses.
___________________
Step 6: Sign below
Under penalties of perjury, I state that this statement of assets and liabilities and other information is, to the best of my knowledge, true, correct,
and complete.
Debtor’s signature______________________________________________________________ Date ___ ___/___ ___/___ ___ ___ ___
Spouse’s signature_____________________________________________________________ Date ___ ___/___ ___/___ ___ ___ ___
This form is authorized as outlined by the Illinois Income Tax Act and the Retailers’ Occupation and related occupation taxes and fees acts.
Disclosure of this information is REQUIRED. Failure to provide information could result in this form not being processed.
EG-13-I back (R-5/12)
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