Form Il-1041 Draft - Fiduciary Income And Replacement Tax Return - 2007 Page 4

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Illinois Department of Revenue
Year ending
*IL07637141332*
Schedule D
____ ____
Beneficiaries’ Identification
Month
Year
Attach to your Form IL-04
IL Attachment No. 1
Write your
Write your name as shown on your Form IL-04.
federal employer identification number (FEIN).
_____________________________________________________________
___ ___ - ___ ___ ___ ___ ___ ___ ___
Identify your beneficiaries.
A
B
C
D
Check the box if
Social Security number
Beneficiary type
the beneficiary is an
Name and Address
or FEIN
(See instructions.)
Illinois non-resident.
1
________________________________
________________________________
________________________________
________________________________
_________________
______
2
________________________________
________________________________
________________________________
________________________________
_________________
______
3
________________________________
________________________________
________________________________
________________________________
_________________
______
4
________________________________
________________________________
________________________________
________________________________
_________________
______
5
________________________________
________________________________
________________________________
________________________________
_________________
______
6
________________________________
________________________________
________________________________
________________________________
_________________
______
7
________________________________
________________________________
________________________________
________________________________
_________________
______
8
________________________________
________________________________
________________________________
________________________________
_________________
______
9
________________________________
________________________________
________________________________
________________________________
_________________
______
Schedule D (R-2/07)
Page 4 of 4

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