Form Nuc-1-H - Request For Household Employer'S Information - Illinois Department Of Revenue

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Illinois Department of Revenue
NUC-1-H
Request for Household Employer’s Information
Do not attach to Form IL-1040
Read this information first
Complete this request if you wish to withhold Illinois Income Tax from your household employees’ compensation and pay the
tax withheld only once a year on April 15. When we receive your completed form, we will send you a Booklet IL-700-H that
contains the necessary withholding information, forms, and tax tables.
Step 1: Provide the following information
1
Household employer’s first name and middle initial
Household employer’s last name
Mailing address
City
State
ZIP
2
___ ___ ___ - ___ ___ - ___ ___ ___ ___
___ ___ - ___ ___ ___ ___ ___ ___ ___
Household employer’s Social Security number
Household employer’s federal employer identification number (if available)
3
Do you currently file or pay Illinois Income Tax using Form IL-501, IL-941, or IL-W-3?
Yes
No
4
If you answered “Yes” to Question 3, do you employ any other non-household employees?
Yes
No
Note:
If you receive your preprinted Illinois Withholding Income Tax Forms for Tax Year 1998 (Forms IL-501, IL-941, and IL-W-3), do not use
these forms to pay the income tax withheld from your household employees if you choose to use this new method. However, you must
continue to use these forms for any other types of employees you may employ.
Step 2: Sign below
Under penalties of perjury, I state that to the best of my knowledge, this form is true, correct, and complete.
(
)
Household employer’s signature
Daytime telephone number
Date
Step 3: Complete your return label and send us your request
Mail to:
Write your name and address (including ZIP code)
in the space provided below. Please print clearly,
ILLINOIS DEPARTMENT OF REVENUE
this will be your return mailing label.
PO BOX 19010
SPRINGFIELD IL 62794–9010
Name
Please do not use the envelope we provided for your
Address
1997 Form IL-1040 to mail your NUC-1-H. We ask
that you use a separate envelope. This will allow us to
City
State
ZIP
properly process your information.
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to
provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3827
NUC-1-H (N-12/97)

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