Form Cpp-1 - Payment Installment Plan Request Form - Illinois Page 2

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Step 3: Figure your monthly payment agreement amount
5 Have all your tax returns been filed?
For this agreement to be considered all returns must be filed.
6 Identify the tax periods covered by this agreement.
______ ______ ______ ______ ______ ______ ______ ______
7 Write the date(s) you want to make your payment each month.
7 _________________
8 Total amount of your unpaid tax liability.
8 $________________
If your liability is over $5,000, you must file Form EG-13-I, or Form EG-13-B.
9 Write the amount of your good faith downpayment.
9 $________________
10 Write the amount you would like to pay each month.
10 $________________
Step 4: Provide your financial institution and account information
Think paperless
it’s automatic and
Financial institution’s name
easy .
for payment
Mailing address
Names on the account (list all names)
Routing number
Checking or
____ ____ ____ ____ ____ ____ ____ ____ ____
Find your routing number at the bottom of your check (for checking accounts) or contact
your financial institution for the routing number (for savings accounts).
Account number
____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
Step 5: Signature authorization for taxpayer, authorized officer, or partner
(ACH payment option only)
The Illinois Department of Revenue is authorized to use the information on this form to make
monthly withdrawals from the account listed in Step 4 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 force until the department receives written notification from the
is the
form of
Your signature
Step 6: Read the statement and sign below
I agree to pay the amount on Line 10 each month on the date(s) specified on Line 7. I under-
stand that, if the department does not agree to the proposed payment amount on Line 10,
additional information about my financial condition may be requested and I may be required to
pay a higher amount. I understand that I must complete Form EG-13-B or Form EG-13-I if my
liability is over $5,000. In addition, liens may be filed at the department’s discretion, includ-
ing, 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 file all future required returns and pay any tax
owed for those periods. If I do not remit the scheduled payment, and file 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 knowl-
edge, it is true, correct, and complete.
Your signature
CPP-1 back (R-12/05)


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