Form Il-941 - Illinois Withholding Income Tax Return - 2015
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Illinois Department of Revenue
Form IL-941
2015
Illinois Withholding Income Tax Return
Quarterly filers: File only one IL-941 return per quarter. Make your payments using IL-501.
Reporting Period
Step 1: Provide your information
Check this
box if this is
If you are a quarterly filer:
0
0
0
your first
___ ___
___ ___ ___ ___ ___ ___ ___
___ ___ ___
Check the quarter you are reporting.
return.
Federal employer identification number (FEIN)
Seq. number
1st
(January, February, March)
Check this
____________________________________________________________
box if your
2nd
(April, May, June)
Business name
business
name has
3rd
(July, August, September)
changed.
____________________________________________________________
C/O
4th
Check this
(October, November, December)
box if your
If you are an annual filer:
____________________________________________________________
address
Check the box if you are not required to file quarterly.
has
Mailing address
changed.
January — December
______________________________
_______
__________________
City
State
ZIP
Step 2: Tell us about your W-2 forms and your business
A
Enter the total number of W-2 forms reporting Illinois withholding, you were required to issue for the
A __________________
entire year. (Quarterly filers — Only complete this line when you file your 4th quarter or final return.)
B
If your business has permanently stopped withholding because it has closed, or you no longer
pay Illinois wages or withhold Illinois taxes from other payments, check the box and enter the date
B
you stopped withholding.
__ __ / __ __ / 2015
Month
Day
Step 3: Tell us about the amount subject to withholding
1
Enter the total dollar amount subject to Illinois withholding tax this reporting period, including payroll,
1 __________________
compensation, and other amounts. See instructions.
Step 4: Tell us about the amount withheld
2
Enter the total dollar amount of Illinois Income Tax actually withheld from your employees or others for this
reporting period. Do not leave this line blank. This line should be zero only if you did not withhold any
2 __________________
Illinois Income Tax during this reporting period.
Step 5: Tell us about your payments and credits
3
Enter the total dollar amount of withholding payments you made to the Illinois Department of Revenue (IDOR)
3 __________________
for this period. This includes all IL-501 payments (electronic and paper coupons). Do not estimate this amount.
4
Enter the amount of IDOR-approved credit you are using this period. Credits are only valid if you have
4 __________________
received written confirmation from IDOR. See instructions.
5
5 __________________
Enter the amount of credit through DCEO you are using this period. See instructions.
6
6 __________________
Add Lines 3, 4, and 5 and enter the total amount here.
Step 6: Figure the amount you owe or your credit
7
If Line 2 is greater than Line 6, subtract Line 6 from Line 2. This is your remaining
balance due. Make your payment electronically or make your remittance payable
7 __________________
to “Illinois Department of Revenue.” (Semi-weekly payers must pay electronically.)
8
If Line 2 is less than Line 6, subtract Line 2 from Line 6. This amount is not available for use on future
8 __________________
IL-941 returns until you receive notification from IDOR verifying this amount. See instructions.
Step 7: Sign here
Under penalties of perjury, I state that, to the best of my knowledge, this return is true, correct, and complete.
Check this box if we may
___________________________________(____)________________ __ __ / __ __ / __ __ __ __
discuss this return with the
Signature
Daytime telephone number
Month
Day
Year
preparer shown in this step.
___________________________________(____)________________ __ __ / __ __ / __ __ __ __
Signature of Preparer
Daytime telephone number
Month
Day
Year
ILLINOIS DEPARTMENT OF REVENUE
Mail to:
NS
DR____
PO BOX 19052
Reset
Print
SPRINGFIELD IL 62794-9052
*IL-941*
IL-941 (R-12/14)
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