Form Il-990-T-X-V - Payment Voucher For Amended Exempt Organization Income And Replacement Tax - 2012

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If no payment is due, do not file this form.
To pay the amount you owe on your IL-990-T-X, Amended Exempt Organization Income and
Replacement Tax Return, complete the IL-990-T-X-V at the bottom of this page and attach it,
along with your payment, to your amended return, and mail them to the address on the voucher.
Illinois Department of Revenue
IL-990-T-X-V
Payment Voucher for Amended Exempt Organization
2012
Income and Replacement Tax
IL-990-T-X-V (R-12/12)
ID: 110
Mail to: Illinois Department of Revenue, P.O. Box 19016, Springfield, IL 62794-9016
If no payment is due, do not file this form.
Tax year ending
0
0
0
FEIN:
SEQ:
Month
Year
Name:
$
C/O:
Print your payment amount on this line.
Mailing
WRITE YOUR FEIN ON YOUR CHECK
address
:
Return this voucher with check or money
order p ayable to “Illinois Department of
City:
State:
ZIP:
Revenue.”
Preparer’s
Phone Number:
Reset
Print

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