Fillable Cpp-1 11/10 - Payment Installment Plan Request

Step 3: Describe your debt and payment installment plan request

Have all your tax returns been ﬁ led?

Yes

For this agreement to be considered, all returns must be ﬁ led.

Identify the tax periods covered by this agreement.

_________ _________ _________ _________ _________ _________ _________

7 $_____________

Total amount of your unpaid tax liability.

If your liability is over $5,000, you must ﬁ le Form EG-13-I or Form EG-13-B.

8 $_____________

Write the amount of your good faith downpayment.

9 $_____________

Subtract Line 8 from Line 7. Write the amount of the balance.

Describe your payment installment plan to pay the amount on Line 9. Write your

ﬁ rst payment date ___ /___ /_______ and complete one of the following options.

_____

$____________

One per month:

Date during month

Amount

_____________

$____________

One per week:

Day of week

Amount

_____________

$____________

One every other week:

Day of week

Amount

Step 4: Provide your ﬁ nancial institution and account information

________________________________________________________

Financial institution’s name

______________________________________________________________________________________

Mailing address

City

State

ZIP

______________________________________________________________________________________

Names on the account (list all names)

___ ___ ___ ___ ___ ___ ___ ___ ___

Routing number

Checking

Savings

Find your routing number at the bottom of your check (for checking accounts) or contact

your ﬁ nancial institution for the routing number (for savings accounts).

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Account number

12 Sign to authorize electronic payments

(taxpayer, authorized ofﬁ cer, or partner)

The Illinois Department of Revenue is authorized to use the information on this form to make monthly

withdrawals (ACH debits) from the account listed

Line 11 in accordance with the Department of Revenue

Law of the Civil Administrative Code of Illinois and all applicable Illinois tax acts. This authorization shall

remain in effect until the department receives written notiﬁ cation from the taxpayer.

______________________________________________________ __ __ / __ __ / __ __ __ __

Your signature

Month day, year

Step 5: Read the statement and sign below

I agree to make the scheduled payments as described

Line 10. I understand that, if the department does not agree to the

payment plan described in Step 3, additional information about my ﬁ nancial condition may be requested and I may be required to

pay a higher amount. I understand that I must complete Form EG-13-I or Form EG-13-B if my liability is over $5,000. In addition,

liens may be ﬁ led at the department’s discretion, including, but not limited to, when the department determines there

is a risk of non-payment. I will make all payments as scheduled and I will ﬁ le all future required returns and pay any tax owed

for those periods. If I do not remit the scheduled payment and ﬁ le all required returns, my payment installment plan may be

canceled; the entire unpaid balance will become due immediately; and enforcement action may be taken, which could include

levy of my bank account or wages.

Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete.

________________________________________________________________ __ __ / __ __ / __ __ __ __

Your signature

Month day, year

CPP-1 Back (R-11/10)

Reset

Cpp-1 11/10 - Payment Installment Plan Request - Illinois Page 2

Related Articles

Related forms

Related Categories