Form Il-941-X Draft - Amended Illinois Quarterly Withholding Tax Return
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1Illinois Department of Revenue
IL-941-X
Amended Illinois Quarterly Withholding Tax Return
Read this information fi rst.
Which parts must I complete?
Everyone must complete Steps 1, 3, and 4 to report changes to any
You must complete this form to report corrections to your Form IL-941.
amounts previously reported on Form IL-941. Complete Step 2 only if
When is Form IL-941-X due?
you are making changes to tax withheld from payments to a recipient.
You should report any increases in your tax due as soon as possible
What if I need additional assistance?
to minimize penalties and interest. If your change decreases your tax
If you need assistance, visit our web site at tax.illinois.gov ; call our
due, you must fi le Form IL-941-X no later than
Taxpayer Assistance Division at 1 800 732-8866 or
• three years after the 15th day of the 4th month following the close
217 782-3336 ; or call our TDD (telecommunications device for the
of the calendar year in which the tax was withheld, or
deaf) at 1 800 544-5304 . Our offi ce hours are 8 a.m. to 5 p.m.
• one year after the date the tax was paid.
Step 1: Complete the following account information.
_______________________________________________________
___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____/____
Business name
Federal employer identifi cation number (FEIN)
Seq. number
Tax yr. Qtr.
_______________________________________________________
Are you a sole proprietor?
___ yes ___ no
Owner(s)
If “yes”, write your
_______________________________________________________
Social Security number
___ ___ ___-___ ___- ___ ___ ___ ___
Number and street
_______________________________________________________
Is this a new address?
___ yes ___ no
City
State
ZIP
(
)
-
____________________________
Daytime telephone number
Step 2: Complete recipient information.
(Complete only if you are making changes to taxes withheld from payments to a recipient.)
Complete Columns A through E to correct withholding errors in the current year only. See Publication 131, Withholding Income Tax Filing and
Payment Requirements.
Column A
Column B
Column C
Column D
Column E
Recipient’s Social Security number
Recipient’s name and state of residency
Amount previously reported on
Net change
Corrected amount
W-2, W-2G, and 1099 forms
increase or (decrease)
1
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
-
-
__________________________
________________
________________
________________
___ ___ ___
___ ___
___ ___ ___ ___
If you need additional space, attach a sheet which follows the format above.
2
2
Add Column C and write the result.
________________
3
3
Add Column D, and write the result here and on Step 3, Line 6, Column B.
________________
4
4
Were W-2-Cs issued? ___ yes ___ no If “yes,” write the date the W-2-Cs were issued.
______ /_______/______________
Month
Day
Year
Step 3: Figure your correct withholding.
Column A
Column B
Column C
Amount previously reported
Net change
Corrected amount
increase or (decrease)
5
Write the amount of compensation and gambling winnings
5
(including Illinois lottery winnings) subject to withholding.
________________
________________
________________
6
Write the total Illinois Income Tax required to be withheld.
6
(If applicable, complete Step 2 before you write an entry.)
________________
________________
________________
7
Write the total amount of payments (i.e., electronic, Form IL-501, and
7
Form IL-941) plus any credit or overpayment from a previous quarter.
________________
________________
________________
8
If Line 6, Column C, is more than Line 7, Column C, write the difference.
8
This is the amount of tax you owe. Make your remittance payable to “Illinois Department of Revenue.”
________________
You may be assessed penalties and interest if this amended return is fi led after the due date
of your original Form IL-941. If so, we will send you a notice.
9
9
If Line 6, Column C, is less than Line 7, Column C, write the difference. This is the amount of your overpayment.
________________
You must answer the following questions.
a
Do you want your overpayment applied to a subsequent quarter? ___ yes ___ no If “yes,” write the year and quarter.________ /_____
Year
Quarter
b
Do you want your overpayment to be refunded to you?
___ yes ___ no
If you have an unpaid liability, your overpayment will be applied to that liability. Any remaining overpayment will be applied as you
specifi ed on Lines 9a or 9b.
10
Write a detailed explanation of your changes (e.g., Step 3, Line 5, Column B, is a decrease in wages and tax previously reported for this quarter).
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
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)
Title
Date
Daytime telephone number
Mail this return to: Illinois Department of Revenue, P.O. Box 19007, Springfi eld, IL 62794-9007
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-492-0048
IL-941-X (R-12/07)
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