Form Il-501 Draft - Payment Coupon And Instructions - 2012 Page 3
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1
2
3Illinois 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
*IL501*
•
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
Pay electronically using WebPay at tax.illinois.gov
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
Check the appropriate box to tell us when you withheld the withholding income
Check the appropriate box to tell us when you withheld the withholding income
IL-501
tax you are paying. Check one box only.
tax you are paying. Check
tax you are paying. Check
one
one
box only.
box only.
2012
Complete the following information.
Tax year
1
2
2
2
3
4
___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Jan
Apr
Apr
Apr
Jul
Oct
Federal employer identification number
Seq. number
Feb
Feb
Feb
May
Aug
Nov
_______________________________________________
Mar
Mar
Mar
Jun
Sep
Dec
Business name
$
Amount paid:
Amount
Amount
paid:
paid:
___________________.____
_______________________________________________
Number and street address
If mailing your payment and this Form IL-501:
If mailing your payment and this Form IL-501:
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
*IL501*
*IL501*
*IL501*
•
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
*IL501*
•
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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