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INSTRUCTIONS FOR COMPLETING DEPARTMENT OF …
The Statement of financial Condition for Individuals, Form12A638, provides the DEPARTMENT of Revenue s Division ofCollections with information that will be utilized in evaluatingan individual s financial position. Every item of the financialstatement must be completed and should reflect accuratestatements and amounts. If an item is not applicable insert N/A. An incomplete Statement of financial Condition forIndividuals may not be Statement of financial Condition for Individuals ispresented in four segments. INSTRUCTIONS have been providedonly for items requiring further clarification. Most of therequested items are self-explanatory. However, if you have aquestion, call (502) Information (Items 1 5)Please verify the Social Security numbers reported in items 1and 5b to make sure they are I Employment Information (Items 6 15)This section should report all full-time and/or part-timeemployers that currently make a payment(s) to you in the formof wages, salaries and/or commissions for services may use attachments as II Assets (Items 16 23)All information furnished in this section should be verified foraccuracy.
The Statement of Financial Condition for Individuals, Form 12A638, provides the Department of Revenue’s Division of Collections with information that will be utilized in evaluating
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