Form Cbs-1 - Notice Of Sale, Purchase, Or Transfer Of Business Assets

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Illinois Department of Revenue
CBS-1
Notice of Sale, Purchase, or Transfer of Business Assets
General information
You (or the purchaser or the transferee) must complete Form CBS-1
If you need additional information, you may call our Chicago office
weekdays between 8:30 a.m. and 5:00 p.m. at 312 814-3063.
if, outside your usual course of business, you sell or transfer the
major part of the
Mail your completed Form CBS-1, a copy of the sales contract, and
financing agreement to:
stock of goods that you are in the business of selling,
furniture or fixtures,
BULK SALES UNIT
machinery and equipment, or
ILLINOIS DEPARTMENT OF REVENUE
real property of your business.
100 WEST RANDOLPH LEVEL 7-400
CHICAGO IL 60601
Forms received more than 10 days after the sale date will not be pro-
cessed. The purchaser or transferee may be held liable for any debt
You may fax your form and sales contract to us at 312 793-3841.
incurred by the seller.
Part 1: Identify the business being sold or transferred and the identification numbers
_______________________________________
3
1 ____________________________________________________
Business name
Illinois business tax number (IBT no.) or account identification number
___ ___-___ ___ ___ ___ ___ ___ ___ ___ ___ ___
2
4
____________________________________________________
Street address
Federal employer identification number (FEIN)
Seq. number
___ ___ ___-___ ___-___ ___ ___ ___
5
____________________________________________________
Street address (if needed)
Social Security number
6
Are you required to pay any excise taxes ?
____________________________________________________
Yes
No
City
State
ZIP
Excise tax number ________________________________________
Part 2: Identify the seller or transferor
(
)
7
9
____________________________________________________
__________________________
Name
Daytime phone number
(
)
8
10
____________________________________________________
____________________________________________________
Home or mailing address
Name of seller’s or transferor’s attorney
Daytime phone number
11
____________________________________________________
____________________________________________________
City
State
ZIP
Address of attorney
Part 3: Identify the purchaser or transferee
12
14
____________________________________________________
____________________________________________________
Name
Purchaser’s or transferree’s IBT no. and FEIN
(
)
13
15
____________________________________________________
____________________________________________________
Home or mailing address
Name of purchaser’s or transferee’s attorney
Daytime phone number
16
____________________________________________________
____________________________________________________
City
State
ZIP
Address of attorney
Part 4: Describe the terms of sale or transfer
___/___/____
17
21
Date business was or will be sold or transferred.
Terms of sale or transfer. Write “X” in the appropriate box, and
provide additional information as requested.
Month
Day
Year
18
Selling price of the business or the value of the business
Cash sale
assets transferred: $ ____________________
Contract sale. Complete the following information:
19
Was the entire business sold or transferred?
Down payment amount:
$ ____________________
Yes
Monthly payment amount:
$ ____________________
___/___/____
No - You must complete Line 20.
Date last payment is due
Month
Day
Year
20
Are the seller’s or transferee’s registration numbers with the
department to remain active?
Conventional financing
Yes
Other (Specify.): ____________________________________
___/___/____
No - Write the date to be discontinued.
_________________________________________________
Month
Day
Year
_________________________________________________
Part 5: Sign below.
This must be completed by the person submitting this Form.
(
)
22
24
____________________________________________________
____________________________________________________
Signature
Date
Print or type your name
Daytime phone number
23
____________________________________________________
Mailing address of person
This form is authorized as outlined by the Illinois Income Tax Act [35 ILCS 5/902] and the Retailers’ Occupation Tax Act [35 ILCS 120/5j]. You are required to report all sales
of businesses to the Illinois Department of Revenue. Disclosure of this information is REQUIRED. Failure to provide such information may result in the purchaser or transferee
becoming personally liable for the amount of tax owed by the seller. This form has been approved by the Forms Management Center.
IL-492-4224
CBS-1 (R-4-09)
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