Form Il-505-B - Automatic Extension Payment - 2003 printable pdf download

Form Il-505-B - Automatic Extension Payment - 2003

IL-505-B front (R-12/03)

— — — — — — — — Return only the bottom portion with your payment. — — — — — — — —

Illinois Department of Revenue

IL-505-B

Automatic Extension Payment for 2003

If no payment is due or you make your payment by

Electronic Funds Transfer, do not file this form.

Tax year ending

____ ___/___ ___ ___ ___

Month

Year

___ ___ - ___ ___ ___ ___ ___ ___ ___

___ ___ ___

Federal employer identification number

Sequence no.

_______________________________________________________

Write the amount of your payment here. __________________

____

Name of organization

Tentative tax due

_______________________________________________________

Street address

_______________________________________________________

City

State

ZIP

(_____)_________________________________________________

Make your check or money order payable to and mail this

Daytime phone number

voucher to:

ILLINOIS DEPARTMENT OF REVENUE

This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is

PO BOX 19045

REQUIRED. Failure to provide information could result in a penalty. This form has been approved

SPRINGFIELD IL 62794-9045

by the Forms Management Center.

IL-492-0067

Form Il-505-B - Automatic Extension Payment - 2003