Fillable Form Cpp-1 - Payment Installment Plan Request Form

Step 3: Figure your monthly payment agreement amount

5 Have all your tax returns been filed?

Yes

For this agreement to be considered all returns must be filed.

Non-filed

6 Identify the tax periods covered by this agreement.

returns

______ ______ ______ ______ ______ ______ ______ ______

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.

EG-13-I

9 Write the amount of your good faith downpayment.

9 $________________

EG-13-B

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

See

Financial institution’s name

easy .

instructions

for payment

options.

Mailing address

City

State

ZIP

Names on the account (list all names)

Routing number

Checking or

Savings

____ ____ ____ ____ ____ ____ ____ ____ ____

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

Electronic

funds

authorization shall remain in force until the department receives written notification from the

withdrawal

is the

taxpayer.

recommended

form of

payment.

__________________________________________________________________________

Your signature

Date

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

Date

CPP-1 back (R-12/05)

RESET

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

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