Form Il-1000-E Draft - Certificate Of Exemption For Pass-Through Entity Payments
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1lllinois Department of Revenue
Certificate of Exemption for Pass-through
Form IL-1000-E
Entity Payments
Read this information first
Pass-through entities:
In order to accept Form IL-1000-E, make sure that the certificate is
Owners:
completed and signed by the owner, officer, fiduciary, or authorized
Form IL-1000-E, Certificate of Exemption for Pass-through Entity
representative.
Payments, should be completed by any owner (partner,
shareholder, or beneficiary) that elects to make their own tax
In the event that we inform you that the certificate has been revoked,
payments on business income from a pass-through entity
the certificate remains valid for 60 days after the date of notification,
(partnership, shareholder, or fiduciary).
and you must begin withholding for business income distributable to
the owner.
Specific information:
Form IL-1000-E must only be completed, signed, and submitted
If the certificate has been revoked, you may not accept another
once to the pass-through entity. It does not need to be resubmitted
certificate from the owner until we notify you.
on an annual basis.
Step 1: Identify the pass-through entity
The pass-through entity must keep this certificate.
( _______ ) ______________________________________
______________________________________________________
Name
Phone number
Federal employer identification number (FEIN)
______________________________________________________
Mailing address
____________________________________________________
__
____ ____ - ____ ____ ____ ____ ____ ____ ____
City
State
ZIP
Step 2: Identify the owner (partner, shareholder, or beneficiary)
Federal employer identification number (FEIN)
_____________________________________________________
Name
_______
_____________________________________________
____ ____ - ____ ____ ____ ____ ____ ____ ____
Mailing address
Check the box to indicate your business type:
___________________________________________________
__
City
State
ZIP
Corporation
Subchapter S corporation
( _______ ) ______________________________________
Partnership
Phone number
Trust
Estate
Step 3: Sign below
I certify that the owner indicated in Step 2 will file all Illinois income tax returns and make timely payment of all Illinois income
taxes due, and that it is subject to personal jurisdiction of the State of Illinois for purposes of the collection of income taxes due
with respect to income from the partnership, corporation or trust indicated in Step 1 of this certificate.
___________________________________________________________________________________ __ __/__ __/__ __ __ __
Signature of owner, officer, fiduciary, or authorized representative
Date
___________________________________________________________________________________ ____________________
Title
Printed name
This form is authorized as outlined by the Registration and Licensing Division and has been approved by the Forms Management Center.
IL-492-4557
IL-1000-E (N-12/08)
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