Form Il-501 - Payment Coupon 2012
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1Pay electronically using WebPay at tax.illinois.gov
Illinois Department of Revenue
Payment Coupon
Check the appropriate box to tell us when you withheld the withholding income
IL-501
tax you are paying. Check one box only.
2012
Complete the following information.
Tax year
1
2
3
4
___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Jan
Apr
Jul
Oct
Federal employer identification number
Seq. number
Feb
May
Aug
Nov
_______________________________________________
Mar
Jun
Sep
Dec
Business name
$
Amount paid:
___________________.____
_______________________________________________
Number and street address
If mailing your payment and this Form IL-501:
_______________________________________________
• Make remittance payable to “Illinois Department of Revenue”
City
State
ZIP
• Mail to:
ILLINOIS DEPARTMENT OF REVENUE
(_______)_______________________________________
PO BOX 19447
Daytime phone
SPRINGFIELD IL 62794-9447
*IL-501*
•
Do not mail Form IL-501 if you electronically pay or are reporting a zero amount.
IL-501 (R-12/11)
Illinois Department of Revenue
Pay electronically using WebPay at tax.illinois.gov
Payment Coupon
Check the appropriate box to tell us when you withheld the withholding income
IL-501
tax you are paying. Check one box only.
2012
Complete the following information.
Tax year
1
2
3
4
___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Jan
Apr
Jul
Oct
Federal employer identification number
Seq. number
Feb
May
Aug
Nov
Mar
Jun
Sep
Dec
_______________________________________________
Business name
$
Amount paid:
___________________.____
_______________________________________________
Number and street address
If mailing your payment and this Form IL-501:
_______________________________________________
• Make remittance payable to “Illinois Department of Revenue”
City
State
ZIP
• Mail to:
ILLINOIS DEPARTMENT OF REVENUE
(_______)_______________________________________
PO BOX 19447
Daytime phone
SPRINGFIELD IL 62794-9447
*IL-501*
•
Do not mail Form IL-501 if you electronically pay or are reporting a zero amount.
IL-501 (R-12/11)
Pay electronically using WebPay at tax.illinois.gov
Illinois Department of Revenue
Payment Coupon
Check the appropriate box to tell us when you withheld the withholding income
IL-501
tax you are paying. Check one box only.
2012
Complete the following information.
Tax year
1
2
3
4
___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Jan
Apr
Jul
Oct
Federal employer identification number
Seq. number
Feb
May
Aug
Nov
_______________________________________________
Mar
Jun
Sep
Dec
Business name
$
Amount paid:
___________________.____
_______________________________________________
Number and street address
If mailing your payment and this Form IL-501:
_______________________________________________
• Make remittance payable to “Illinois Department of Revenue”
City
State
ZIP
• Mail to:
ILLINOIS DEPARTMENT OF REVENUE
(_______)_______________________________________
PO BOX 19447
Daytime phone
SPRINGFIELD IL 62794-9447
*IL-501*
•
Do not mail Form IL-501 if you electronically pay or are reporting a zero amount.
IL-501 (R-12/11)
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Parent category: Financial