Form Il-1120-St-X - Amended Small Business Corporation Replacement Tax Return - 2012 Page 4

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Illinois Department of Revenue
Year ending
Schedule B
Month
Year
Partners’ or Shareholders’ Identification
Attach to your Form IL-1065 or Form IL-1120-ST
IL Attachment no. 1
Write your
Write your name as shown on your Form IL-1065 or Form IL-1120-ST.
federal employer identification number (FEIN).
Step 1: Provide the following information
1
1
Write the amount of base income or net loss from your Form IL-1065 or Form IL-1120-ST, Line 47.
2
2
Write the apportionment factor from your Form IL-1065 or Form IL-1120-ST, Line 42.
Step 2: Identify your partners or shareholders.
Attach additional sheets if necessary.
A
B
C
D
E
F
G
Total amount of
Member
Pass-through
Excluded from
Partner or
base income (loss)
subject to Illinois
entity payment
pass-through
Shareholder type
distributable
replacement tax
amount
entity payments
Name and Address
SSN or FEIN
(See instructions.)
(See instr.)
(See instr.)
(See instr.)
(See instr.)
1
2
3
4
5
6
7
Add the amounts shown in Column D for partners or
shareholders for which you have entered a check mark
7
in Column E. Write the total here. (See instructions.)
Schedule B (R-12/12)
Page 4 of 4
IL-1120-ST-X (R-12/12)
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