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Illinois Department of Revenue
REG-1
Illinois Business Registration Application
Register faster on-line at tax.illinois.gov. If you are already registered and need to make changes (e.g., adding a location, adding a tax
responsibility, changing officer information), call us weekdays between 8:00 a.m. and 4:30 p.m. at 217 785-3707.
Step 1: Identify your business or organization
1
6
Federal employer identification number (FEIN)
Check the organization type that applies to you:
Proprietorship. Check if owned by husband and wife: _____
FEIN: ______ - __________________
Partnership
Trust or estate
If you are a proprietorship, provide the Social Security
Corporation
S Corp (Subchapter S Corporation)
number (SSN) under which taxes will be filed.
Governmental unit
Not-for-profit organization
SSN: _________ - ______ - ____________
Limited liability company (LLC) treated as a
____ Corporation
2
Legal business name - if proprietorship, see instructions.
____ Partnership
___________________________________________________
____ Proprietorship
3
Doing-business-as (DBA), assumed, or trade name, if different
Check here if disregarded: _____
from Line 2.
___________________________________________________
7
Illinois Secretary of State identification (corporate or file) number:
4
Primary or legal business address.
___ - ___ ___ ___ ___ - ___ ___ ___ - ___
___________________________________________________
8
Is your business part of a unitary group?
___ Yes
___No
Street address - No PO Box number
Apartment or suite number
If “Yes”, provide the FEIN of your designated agent (the person
___________________________________________________
responsible for filing your Illinois income tax return):
City
State
ZIP
FEIN: ______ - __________________
Check here if this is your only Illinois location. If you have
more Illinois locations, complete Schedule REG-1-L.
9
Identify a contact person regarding your business.
5
Mailing address if different from the address above.
Name: __________________________________________
___________________________________________________
In-care-of name
Phone: (______) ______ - ________ Ext.: __________
___________________________________________________
Street address or PO Box number
Apartment or suite number
FAX:
(______) ______ - ________
___________________________________________________
City
State
ZIP
Email address: _____________________________________
Step 2: Identify your owners, officers, and general partners
-
if a limited liability company, include the manager
10
Identification depends on your organization type. If you need to identify more, attach Schedule REG-1-O.
Individuals:
d
___________________________________
_________________
a
___________________________________
_________________
Name
Title
Name
Title
(____) _____ - ________
_______________________________
(____) _____ - ________
_______________________________
Home street address - No PO Box number
Telephone
Home street address - No PO Box number
Telephone
______________________________________________________
______________________________________________________
City
State
ZIP
City
State
ZIP
____ / ____ / ________
______ - _____ - _________
____ / ____ / ________
______ - _____ - _________
SSN
Date of birth
SSN
Date of birth
Businesses that are owners, managers, or general partners:
b
___________________________________
_________________
a
___________________________________ ____-_____________
Name
Title
Name
FEIN
(____) _____ - ________
_______________________________
______________________________________________________
Home street address - No PO Box number
Telephone
Legal address
______________________________________________________
______________________________________________________
City
State
ZIP
City
State
ZIP
____ / ____ / ________
______ - _____ - _________
(______) ______ - ________
SSN
Date of birth
Telephone
c
___________________________________
_________________
b
___________________________________ ____-_____________
Name
Title
Name
FEIN
(____) _____ - ________
_______________________________
______________________________________________________
Home street address - No PO Box number
Telephone
Legal address
______________________________________________________
______________________________________________________
City
State
ZIP
City
State
ZIP
____ / ____ / ________
______ - _____ - _________
SSN
(______) ______ - ________
Date of birth
Telephone
REG-1 (R-11/09)