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Illinois Department of Revenue
CBS-1
Notice of Sale, Purchase, or Transfer of Business Assets
Type or print clearly in Steps 1 through 6 of this form and read the instructions on the back of this page.
Step 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
____________________________________________________
City
State
ZIP
Step 2: Identify the seller or transferor
6
9
____________________________________________________
____________________________________________________
Name
Name of seller’s or transferor’s attorney
7
10
____________________________________________________
____________________________________________________
Home or mailing address
Attorney street address
____________________________________________________
____________________________________________________
City
State
ZIP
8
(
)
(
)
11
(
)
(
)
____________________________________________________
____________________________________________________
Daytime phone number
FAX number
Attorney’s daytime phone number
FAX number
Step 3: Identify the purchaser or transferee
12
15
____________________________________________________
____________________________________________________
Name
Purchaser’s or transferree’s IBT no. and FEIN
13
16
____________________________________________________
____________________________________________________
Home or mailing address
Name of purchaser’s or transferee’s attorney
Daytime phone number
17
____________________________________________________
____________________________________________________
City
State
ZIP
Attorney address
14
(
)
(
)
18
(
)
(
)
____________________________________________________
____________________________________________________
Daytime phone number
FAX number
Attorney’s daytime phone number
FAX number
Step 4: Describe the terms of sale or transfer
___/___/____
19
23
Terms of sale or transfer. Write “X” in the appropriate box, and
Date business was or will be sold or transferred.
provide additional information as requested.
Month Day
Year
Cash sale
20
Selling price of the business or the value of
the business assets transferred:
$ ____________________
Contract sale. Complete the following information:
21
•
Was the entire business sold or transferred?
Down payment amount:
$ ____________________
•
Yes
Monthly payment amount:
$ ____________________
___/___/____
•
No - You must complete Line 22.
Date last payment is due
Month Day
Year
22
Are the seller’s or transferee’s registration numbers with the
department (shown on Line 3) to remain active?
Conventional financing
Yes
Other (Specify.): ____________________________________
___/___/____
No - Write the date to be discontinued.
_________________________________________________
Month Day
Year
_________________________________________________
Continued on back page
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. 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
CBS-1 (R-08/16) front
for the amount of tax owed by the seller.