Form Il-1041-V - Payment Voucher For Fiduciary Income And Replacement Tax - 1999
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4Illinois Department of Revenue
Payment Voucher for Fiduciary
IL-1041-V
1999
Income and Replacement Tax
SCAN LINE FIELDS
1.
Form Code - Always 10418 (5)
2.
Liability Period - mmyy (4)
3.
Form Code, Liability Period Check Digit (1)
4.
Federal Employer Identification Number (9)
5.
Sequence Number - Normally 000 (3)
6.
FEIN, Sequence Number Check Digit (1)
7.
Payment Amount - includes cents(11)
FORM FIELDS
1.
Federal Employer Identification Number
2.
Sequence Number - Normally 000
3.
FEIN, Sequence Number Check Digit
4.
Tax Year Ending Month
5.
Tax Year Ending Year
6.
Illinois Business Tax (IBT) Number
7.
Business Name and Address
Illinois Department of Revenue
Payment Voucher for Fiduciary
IL-1041-V
1999
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Income and Replacement Tax
IL-1041-V (N-9/99)
FEIN
26-3948363 000 1
Mail to Illinois Department of Revenue, P.O. Box 19009, Springfield, IL 62794-9009
IBT
9999-9999
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7
Tax year ending
Anybody’s Plumbing and Heating
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12
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99
Make sure the BusinessName, FEIN,
9999 Where Blvd
Month
Year
and Payment amount are correct.
Anywhere, IL 99999
Print your payment amount on this line.
WRITE YOUR FEIN ON YOUR CHECK
Preparers Phone Number_______________
104181299 1 263948363 000 1 00000000000
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