Form Il-941-X - Amended Illinois Withholding Income Tax Return - 2017

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Illinois Department of Revenue
Form IL-941-X
2017
Amended Illinois Withholding Income Tax Return
Step 1: Provide your information
___ ___
___ ___ ___ ___ ___ ___ ___
___ ___ ___
Reporting Period
Federal employer identification number (FEIN)
Seq. number
Check this
____________________________________________________________
Check the quarter you are amending.
box if your
Business name
business
1st
(January, February, March)
name has
____________________________________________________________
changed.
2nd
(April, May, June)
C/O
Check this
____________________________________________________________
3rd
(July, August, September)
box if you
Mailing address
have an
4th
(October, November, December)
address
______________________________
_______
__________________
change.
City
State
ZIP
Step 2: Tell us about your business
A
A
If you have submitted your Forms W-2 and W-2c for this year electronically, check this box.
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
B
and enter the date you stopped withholding.
__ __ / __ __ / 2017
Month
Day
C
Check Box C if
• you are not subject to the Illinois Secure Choice Savings Program Act (820 ILCS 80/), or
• you are subject to the Illinois Secure Choice Savings Program Act (820 ILCS 80/) and you offer
a qualified retirement savings plan, such as a pension or 401(k), to your employees.
For more information, see the instructions or go to illinoisretirement.gov.
C
Step 3: Tell us about the amount subject to withholding
Corrected amount
1 Enter the total dollar amount subject to Illinois withholding tax this reporting
1 __________________
period, including payroll, compensation, and other amounts. See instructions.
Step 4: Tell us about the amount withheld and previous overpayments
2
Enter the exact amount of Illinois Income Tax you actually withheld from your employees or others on the day
you paid the compensation. Only enter amounts on days you made withholding - leave the remaining “Day” lines
blank. If you withheld no Illinois Income Tax during the month, enter “0” on the corresponding “Total” line - Line 2a,
2c, or 2d (noted by “ ”).
2a First month of quarter
(i.e., January for 1st quarter; April for 2nd quarter; July for 3rd quarter; and October for 4th quarter)
Day
Amount
Day
Amount
Day
Amount
Day
Amount
____________.___
____________.___
____________.___
____________.___
1
9
17
25
____________.___
____________.___
____________.___
____________.___
2
10
18
26
____________.___
____________.___
____________.___
____________.___
3
11
19
27
____________.___
____________.___
____________.___
____________.___
4
12
20
28
____________.___
____________.___
____________.___
____________.___
5
13
21
29
____________.___
____________.___
____________.___
____________.___
6
14
22
30
____________.___
____________.___
____________.___
____________.___
7
15
23
31
____________.___
____________.___
____________.___
8
16
24
____________.___
Total Illinois Income Tax withheld this month. (Add Section 2a, Lines 1-31.)
2a
Continue to Page 2.
ILLINOIS DEPARTMENT OF REVENUE
Mail all pages to:
PO BOX 19016
SPRINGFIELD IL 62794-9016
IL-941-X Page 1 (R-12/16)

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