Form Il-941-A-X - Amended Illinois Yearly Withholding Tax Return - 2009
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Illinois Department of Revenue
IL-941-A-X
Amended Illinois Yearly Withholding Tax Return
Read this information first.
Which steps must I complete?
You must complete Steps 1, 3, and 4 to report changes to any amounts
Only complete IL-941-A-X to correct a previously filed Form IL-941-A.
previously reported on Form IL-941-A. Complete Step 2 only if you are
When is Form IL-941-A-X due?
making changes to tax withheld from payments to a recipient.
Report increases in your tax due immediately to minimize penalties and inter-
What if I need assistance?
est. If your change decreases your tax due, file IL-941-A-X no later than
Visit our web site at tax.illinois.gov or call weekdays between 8:00 a.m.
• three years after the 15th day of the 4th month following the close of
and 5:00 p.m. at 1 800 732-8866, 217 782-3336, or our TDD (telecommu-
the calendar year in which the tax was withheld, or
nications device for the deaf) at 1 800 544-5304.
• one year after the date the tax was paid.
Where do I mail my completed IL-941-A-X?
You may be assessed penalties and interest if IL-941-A-X is filed after the
Illinois Department of Revenue, P.O. Box 19007, Springfield, IL 62794-9007
due date of your original Form IL-941-A. If so, we will send you a notice.
Step 1: Complete account information
_______________________________________________________
___ ___ - ___ ___ ___ ___ ___ ___ ___
___ ___ ___
Business name
Federal employer identification number (FEIN)
Sequence number
_______________________________________________________
___ ___ ___ ___
Owner(s)
Tax year you are correcting
_______________________________________________________
Are you a sole proprietor?
Yes
No
Number and street address
If “yes”, provide your
_______________________________________________________
Social Security number ___ ___ ___ - ___ ___ - ___ ___ ___ ___
City
State
ZIP
(
)
_______________________________________________________
Is this a new address?
Yes
No
Daytime telephone number
Step 2: Complete recipient information
only if making changes to taxes withheld from payments to a recipient
-
Column A
Column B
Column C
Column D
Column E
Recipient’s Social Security
Recipient’s name and
Amount previously reported on
Net change
number (SSN)
state of residency
W-2, W-2G, and 1099 forms
increase or (decrease)
Corrected amount
1
-
-
__________________________
________________
________________
________________
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___ ___
___ ___ ___ ___
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
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-
__________________________
________________
________________
________________
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If you need to identify more, attach a sheet that follows this format.
2
2
Add Column C and write the result here.
________________
3
3
Add Column D and write the result here and on Step 3, Column B, Line 6.
________________
4
4 __ __ / __ __ / __ __ __ __
Were W-2-C forms issued?
Yes
No If “yes,” write the date issued.
Month
Day
Year
Step 3: Figure your correct withholding
Column A
Column B
Column C
Amount previously
Net change
reported
increase or (decrease)
Corrected amount
5
Write the total compensation and gambling winnings (including
5
Illinois Lottery winnings) subject to Illinois withholding.
_______________
________________
________________
6
Write the Illinois Income Tax required to be withheld. This line must be
6
completed. If applicable, complete Step 2 before you write an entry.
_______________
________________
________________
7
Write the total withholding payments (electronic and IL-501), plus any
7
overpayment from a previous IL-941 or IL-941-A if an annual filer last yr.
_______________
________________
________________
8
8
If Column C, Line 6 is more than Column C, Line 7, write the difference here. This is the tax you owe.
________________
Make your remittance payable to “Illinois Department of Revenue”.
9
9
If Column C, Line 6, is less than Column C, Line 7, write the difference here. This is your overpayment.
________________
a
Do you want your overpayment applied to a subsequent year?
Yes
No
If “yes”, write the year and, if you are now a quarterly filer, the quarter.
___ ___ ___ ___ / ___ ___
Tax year
Quarter
b
Do you want your overpayment to be refunded to you?
Yes
No
Your overpayment will first be applied to any unpaid Illinois tax liability. Any remaining amount will be applied as you specified above.
10
Write a detailed explanation of your changes (e.g., Step 3, Column B, Line 5, is a decrease in wages and tax previously reported for this year).
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Step 4: Sign below
Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete.
(
)
_________________________________ __________________________ __________ __________________
Authorized signature (full name required)
Title
Date
Daytime telephone number
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide
IL-941-A-X (R-12/09)
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-4542
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