Schedule I - Illinois Income Received

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Illinois Department of Revenue
Year ending
Schedule I
Income Received
Month
Year
Attach to your Form IL-1041.
IL Attachment No. 8
Enter your
Enter your name as shown on your Form IL-1041.
federal employer identification number (FEIN).
Identify the entities from whom you received income
A
B
C
Type
Name and address
FEIN
(see instructions)
1
2
3
4
5
6
7
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this
*463901110*
information is REQUIRED. Failure to provide information could result in a penalty.
Schedule I (IL-1041) (R-12/14)
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