Form Itr-1 - Request For Tax Clearance - Illinois Department Of Revenue
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Illinois Department of Revenue
ITR-1 Request for Tax Clearance
Read this information first
•
Form ITR-1 will not be processed until all returns are filed and balances paid (including penalty and interest, if applicable).
•
Allow at least 10 business days for processing of Form ITR-1.
•
If you are selling or have sold your business assets, do not complete Form ITR-1, Request for Tax Clearance. You must complete
Form CBS-1, Notice of Sale or Purchase of Business Assets.
•
If you need assistance in completing Form ITR-1, you can contact us at 1 800 732-8866 or at the address listed below.
Step 1: Identify yourself or your business
1
9
Name: _____________________________________________________
Date business started in Illinois :_____/_____/_____
Month
Day
Year
2
10
Doing business as (DBA):______________________________________
Do you make retail sales in Illinois?
yes
no
3
11
Street address: ______________________________________________
Do you maintain an office in Illinois?
yes
no
12
City, state, ZIP: ______________________________________________
Do you have employees in Illinois?
yes
no
4
13
Telephone (include area code): (______)______-__________
If this tax clearance is to be sent to a third party, provide the
following:
5
Federal Employer Identification number (FEIN): __ __-__ __ __ __ __ __ __
Name: ________________________________________
6
Illinois Business Tax number (IBT no.): __ __ __ __-__ __ __ __
In-care-of name: ________________________________
7
Social Security number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Address:_______________________________________
Number and street or post office box
8
Excise Tax License number:_______________________________
City, state, ZIP:__________________________________
Step 2: Check the taxes for which you are requesting tax clearance
a
e
Business income tax
Retailer’s occupation tax (including sales and use taxes)
b
f
Withholding income tax
Hotel/motel tax
c
g
Individual income tax
Automobile renting tax
d
Excise tax. Specify tax type(s):_______________________________
Step 3: Check the reason you are requesting tax clearance
Real estate transaction
Bank closing
Required by a state other than Illinois
Other. Please explain:_____________________________________________________________________________________
Step 4: Sign below
An owner or officer of the business requesting the tax clearance must complete this step. Signature stamps are not acceptable.
Note: If you have been appointed as power of attorney for the taxpayer requesting this tax clearance, you must attach a copy of your power of
attorney that specifically states your authorization in tax related situations. See Form IL-2848, Power of Attorney.
_________________________________________ _____/_____/_____
Title: _____________________________________________
Signature
Month
Day
Year
Title (i.e., president, owner, partner, individual)
Step 5: Send your request
ILLINOIS DEPARTMENT OF REVENUE
PROBLEMS RESOLUTION, (3-515)
Fax: 217 785-2643
PO BOX 19014
SPRINGFIELD IL 62794-9014
Official Use Only
This is your approved tax clearance approved for the taxes identified in Step 2, boxes _________________________________, per your
request. Note: This tax clearance does not preclude assessment for any liability for pending, current, or future taxes or liabilities that may be
established by present or future audits conducted by the department.
Clerk ID: ____________
Signature: ________________________ _____/_____/_____
Month
Day
Year
This form is authorized as outlined by the Retailers’ Occupation Tax Act and Income Tax Act. Disclosure of this information is REQUIRED. Failure to
provide information could result in the denial of your request. This form has been approved by the Forms Management Center.
IL-492-2867
ITR-1 (R-03/07)
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