Form Icb-1 - Request For Informal Conference Board Review - Illinois
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Illinois Department of Revenue
ICB-1
Request for Informal Conference Board Review
Read this information first
√
You must complete Steps 1, 3, 4, 5, and 6. Complete Step 2 if
By completing and filing this form, you are requesting that the
someone will represent you during the informal conference
Informal Conference Board (ICB) conduct an informal review to
examine the basis for a Notice of Proposed Deficiency, Notice of
process.
√
Proposed Liability, or Notice of Proposed Claim Denial issued by the
If you are requesting an in-person conference with the ICB, you
Illinois Department of Revenue. If you did not receive one of these
must make the request in Step 4.
notices, do not file this form.
√
Complete and attach Form ICB-2, Offer of Disposition of a
Note: Do not complete this form if you are requesting a review of an
Proposed Assessment or Claim Denial, if you are making an offer
offer in compromise based on an inability to pay an undisputed tax
of disposition as part of this review request.
liability. These offers must be made by filing a petition with the Board
√
You must file this request within 60 days of the date of the Notice
of Appeals after a final assessment of the tax has been issued.
of Proposed Deficiency, Notice of Proposed Liability, or Notice of
Proposed Claim Denial. This date is the later of the date appear-
ing on the face of the notice or the postmark date.
Step 1: Identify yourself, your business, or your organization
1
_________________________________
5
___ ___ ___ ___ ___ ___ ___ ___ ___
Taxpayer’s name
FEIN
Federal employer identification number
2
_________________________________
6
___ ___ ___ ___ ___ ___ ___ ___
Current address
IBT no.
Street address
Illinois business tax number
_________________________________
7
____________________________________
Excise Tax no.
City
State
ZIP
8
_____________________________________
License no.
________________________________
Daytime phone no.
9
Corporate income tax audits only:
______________________________
Fax no.
Complete the following information if you filed as a member of a
unitary group or the auditor proposed that you should be a
3
_________________________________
Contact person
member of a unitary group.
(For business or organization)
________________________________
________________________________
Daytime phone no.
a Sch. UB filer name
4
___ ___ ___ ___ ___ ___ ___ ___ ___
SSN
b Sch. UB filer FEIN ___ ___ ___ ___ ___ ___ ___ ___ ___
Social Security number
Step 2: Identify your representative
Complete all the information requested in this step if someone will represent you during the informal conference process.
Note: Your representative must attach a properly executed Form IL-2848, Power of Attorney.
1
4
Representative’s name
_______________________________
Check this box if all correspondence should be sent to your
representative’s address.
2
Representative’s address _______________________________
Street address
If you checked the box, all correspondence from the ICB will be
_______________________________
mailed to this address.
City
State
ZIP
If you did not check the box, all correspondence from the ICB will
3
Daytime phone no. ____________________________________
be mailed to the address provided in Step 1.
Fax no.
____________________________________
Step 3: Provide the following audit or examination information
Note: You must attach a copy of the Notice of Proposed Deficiency, Notice of Proposed Liability, or Notice of Proposed Claim Denial and any
attachments you received from us.
1
3
Write the track number from the
Write the audit period and the amount of the proposed
notice you received.
____________________________
assessment or claim denial.
2
Write the tax type.
____________________________
Audit period: ______________________________
Amount:_________________________________
Disclosure of this information is VOLUNTARY. This form has been approved by the Forms Management Center. IL-492-3462
ICB-1 (R-03/07)
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