Form Il-1041 - Fiduciary Income And Replacement Tax Return - 2004
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1
2Illinois Department of Revenue
Fiduciary Income and
2004 Form IL-1041
Replacement Tax Return
or fiscal year beginning ___ ___/___ ___, 2004, ending ___ ___/___ ___, 20___ ___.
Due on or before the 15th day of the 4th month following the close of the tax year.
Do not write above this line.
__________________________________________________________________
|___|___| - |___|___|___|___|___|___|___|
Type
Name and/or number of trust or estate
Federal employer identification number (FEIN)
__________________________________________________________________
|___|___|___|___| - |___|___|___|___|
or
C/O
Illinois business tax (IBT) number
Trust
Estate
__________________________________________________________________
print
Mailing address
ESBT
Individual bankruptcy estate
__________________________________________________________________
Resident of Illinois?
Yes
No
City
State
ZIP
Check the box, if this is your:
First return
Check the box if your name or address has changed.
Final return and date
__ __/__ __/__ __ __ __
Part I — Base income or loss
1
1
Write your federal taxable income or loss before FNOLD from the worksheet (See instructions.)
____________|____
2
Additions
A Fiduciary
B Beneficiaries
a
2a
Exemption claimed on U.S. Form 1041, Page 1
____________ ____________
b
2b
Illinois income and replacement tax deducted in arriving at Line 1 above
____________ ____________
c
2c
State, municipal, and other federally tax-exempt interest (See instructions.)
____________ ____________
d
2d
Other additions (specify:____________________________________)
____________ ____________
e
2e
Add Lines 2a through 2d. This is the total of your additions.
____________ ____________
Report Column B, Lines 2b through 2d, on Schedule K-1-T, Step 5.
2
Write the amount shown on Column A, Line 2e, here.
____________|____
3
3
Add Lines 1 and 2. This is your total income.
____________|____
4
Subtractions
A Fiduciary
B Beneficiaries
a
4a
August 1, 1969, valuation limitation amount from Schedule F
____________ ____________
b
4b
Payments from certain retirement plans (See instructions.)
____________ ____________
c
4c
Interest income from U.S. Treasury and other exempt federal obligations
____________ ____________
d
4d
Retirement payments to retired partners
____________ ____________
e
4e
Enterprise Zone Dividend Subtraction from Schedule 1299-B
____________ ____________
f
High Impact Business within a Foreign Trade Zone
4f
(or sub-zone) Dividend Subtraction from Schedule 1299-B
____________ ____________
g
4g
Other subtractions (specify:__________________________________)
____________ ____________
h
4h
Add Lines 4a through 4g. This is the total of your subtractions.
____________ ____________
Report Column B, Lines 4b through 4g, on Schedule K-1-T, Step 5.
4
Write the amount shown on Column A, Line 4h, here.
____________|____
5
Subtract Line 4 from Line 3. This is your Illinois base income or loss.
If the trust or estate is a resident of Illinois, write this amount on Part III, Line 1a.
5
If the trust or estate is a nonresident of Illinois, write this amount on Sch. NR, Part III, Line 2, and then complete Sch. NR.
____________|____
Part II — Total tax
1
1
Write the net replacement tax from Part III, Line 7 (trusts only).
___________|____
2
2
Write the net income tax from Part IV, Line 7.
___________|____
3
3
Add Lines 1 and 2. This is your total net income and replacement tax.
___________|____
4
Add the total Illinois income tax withheld on wages (attach Forms W-2), tax paid with Form IL-505-B,
4
and any 2003 overpayment credited to 2004 tax. This is the total of your payments and credits.
___________|____
5
5
Overpayment. Subtract Line 3 from Line 4.
___________|____
a
5a
Write the amount of overpayment to be credited to 2005.
____________|____
6
6
Tax due. Subtract Line 4 from Line 3. This is the balance of tax due. (See instructions.) Pay in full if $1 or more.
___________|____
Do not write in this box.
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
Sign
________________________________________________/____/_____
(____)_________________
Signature of fiduciary
Date
Phone
here
________________________________________________/____/_____
_________________________
Check if self-
employed
Signature of preparer
Date
Preparer’s SSN, FEIN, or PTIN
________________________________
________________________________________________
(____)____________
Preparer firm’s name (or yours, if self-employed)
Address
Phone
Mail this return to: Illinois Department of Revenue, P.O. Box 19009, Springfield, IL 62794-9009
NS TS
FI
ME
NR
NT
OC
SC
OB
OS
OT
MA
XX
MC
LF
ED
IM AL______
DR_____________
ID___________
IL-1041 front (R-12/04)
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