Form Boa-1 - Board Of Appeals Petition Page 3
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48 (continued)
If your business is a closely held corporation or partnership (having fewer than 10 shareholders or partners), list all corpo-
rate shareholders or partners, and write the address and Social Security number for each.
Name
Address
Social Security number
___________________________
________________________________________
__ __ __ __ __ __ __ __ __
___________________________
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___________________________
________________________________________
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___________________________
________________________________________
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___________________________
________________________________________
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___________________________
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___________________________
________________________________________
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___________________________
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___________________________
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9
Do you own or have you owned any nonpublicly traded business doing business in Illinois within the last 10 years?
yes
no
If you answered “yes,” write the business name, the business address, the time period during which you owned the busi-
ness, the principal business activity, federal employer identification number, and any appropriate Illinois business tax
numbers.
Do any of these businesses currently have outstanding Illinois tax liability?
yes
no
10
The Board of Appeals will decide your case based upon your written petition and supporting documentation. The board will
also grant you a hearing to discuss your petition if you so desire.
Are you requesting a hearing at the Board of Appeals?
yes
no
If you answered “yes,” indicate where you are requesting that the hearing be conducted.
Chicago
Springfield
If you have travel limitations, please explain.
BOA-1 (R-1/01)
Page 3
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