Form EG-13-I at a glance
What it is: Form EG-13-I is the Illinois Department of Revenue Financial and Other Information Statement for Individuals.
Who signs: Debtor's signature with Date, and Spouse's signature with Date.
A filled-in Form EG-13-I example: Step 1, yourself and your employer
How to fill out Form EG-13-I, box by box
Step 1: Tell us about yourself and your employment
Note: The Illinois Department of Revenue may require support for amounts shown on this form.
Under Debtor's information, enter 1 Your name, Street address, City, State and ZIP; under Employment information, enter 7 Employer's name, Address, City, State and ZIP.
Enter 2 Email address, 3 Home phone, 8 Work phone and 9 Length of employment.
Enter 4 Date of birth, 5 Social Security number and 6 Number of dependents in household.
Step 2: Tell us about other income and property
Step 2: Other income and property. Attach an additional sheet, if necessary.
Enter 10 Real property (brief description and location).
11 List the name and address of the banks where you have accounts: Name, Address, City, State and ZIP.
Enter 12 Vehicle license number and Vehicle description.
Step 3: Tell us if bankruptcy is pending
Step 3: 13 Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? yes no
Enter 14 Bankruptcy number and 15 Date filed.
More rules for Form EG-13-I
Step 4: Complete the following statement of assets and liabilities: 16 Bank accounts, 17 Household furniture, 18 Home mortgage, 19 Rental properties, 20 Real property, 21 Vehicles (model/year), 22 Other assets (describe), 23 Federal taxes outstanding, 24 State taxes outstanding, 25 Accounts/notes payable, 26 Charge cards, 27 Other (include judgments) and 28 Total.
Step 5: Complete the following monthly income and expense analysis. Household monthly income: 29 Your take home pay, 30 Your spouse's take home pay, 31 Pensions, 32 Rental income, 33 Other (specify). 34 Add Lines 29 through 33. Monthly expenses: 35 Rent (if no home mortgage in Step 4), 36 Groceries, 37 Monthly payments (from Line 28), 38 Utilities, 39 Auto expenses (i.e., insurance, gas), 40 Child support paid, 41 Other (specify).
42 Add Lines 35 through 41.
43 Subtract Line 42 from Line 34. This amount is your monthly net income after expenses.
Disclosure of this information is REQUIRED.
Failure to provide information could result in this form not being processed.
Common questions about Form EG-13-I
Who signs it?
Debtor's signature with Date. Spouse's signature with Date.
What am I certifying when I sign?
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.
Sources
[1] Form EG-13-I (R-5/12), Illinois Department of Revenue (the Official source link on this page).