Form Il-941-X - Amended Illinois Withholding Income Tax Return - 2015
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Illinois Department of Revenue
Form IL-941-X
2015
Amended Illinois Withholding Income Tax Return
Step 1: Provide your information
Reporting Period
If you are a quarterly filer:
___ ___
___ ___ ___ ___ ___ ___ ___
___ ___ ___
Check the quarter you are amending.
Federal employer identification number (FEIN)
Seq. number
Check this
1st
____________________________________________________________
(January, February, March)
box if your
Business name
business
2nd
(April, May, June)
name has
____________________________________________________________
changed.
3rd
(July, August, September)
C/O
Check this
____________________________________________________________
4th
(October, November, December)
box if you
Mailing address
have an
If you are an annual filer:
address
______________________________
_______
__________________
Check the box if you are amending an annual return.
change.
City
State
ZIP
January — December
Step 2: Tell us about your business
A
If your business has permanently stopped withholding because it has closed, or you
no longer pay wages or withhold Illinois taxes from other payments, check the box
A
and enter the date you stopped withholding.
__ __ / __ __ / 2015
Month
Day
Step 3: Tell us about the amount subject to withholding
Column A
Column B
Most recent amount reported
Corrected amount
1
Enter the total dollar amount subject to Illinois withholding income tax this reporting period,
1 __________________ 1 __________________
including payroll, compensation, and other amounts. See instructions.
Step 4: Tell us about the amount withheld and previous overpayments
2
Enter the total dollar amount of Illinois Income Tax actually withheld from your employees
or others for this reporting period. Do not leave this line blank. This line should be zero
2 __________________
2 __________________
only if you did not withhold any Illinois Income Tax during this reporting period.
If applicable, attach W-2-C forms.
3
If your original return or previously filed IL-941-X resulted in a credit that you were
previously allowed to use, any IDOR-approved credit for the period, or a refund you
3 __________________
have already received, please enter this amount. See instructions.
4
4 __________________
Add Column B, Lines 2 and 3 and enter the total amount here.
Step 5: Tell us about your payments and credits
5
Enter the total dollar amount of withholding payments you have made to IDOR for this period.
This includes all IL-501 payments (electronic and paper coupons), as well as any subsequent
5 __________________ 5 __________________
payments. Do not include any penalty or interest paid. Do not estimate this amount.
6
Enter the amount of IDOR-approved credit you are using this period. Credits are
6 __________________ 6 __________________
only valid if you have received written confirmation from IDOR. See instructions.
7
7 __________________
7 __________________
Enter the amount of credit through DCEO you are using this period.
8
8 __________________ 8 __________________
Add Lines 5 through 7 and enter the total amount here.
Step 6: Figure the amount you owe or your credit
9
If Column B, Line 4 is greater than Column B, Line 8, subtract Column B, Line 8, from Line 4. This is your remaining
balance due. Make your payment electronically or make your remittance payable to “Illinois Department
9 _________________
of Revenue” and go to Step 7. (Semi-weekly payers must pay electronically.)
10
10 _________________
If Column B, Line 4 is less than Column B, Line 8, subtract Line 4 from Column B, Line 8. This is your overpayment.
Note: You must complete Line 11.
11
Check the appropriate box to tell us what to do with your overpayment and
Credit
complete the Overpayment Worksheet on Page 2 to explain the reason
for your overpayment. Note: Checking the refund box does not guarantee a refund.
Refund
Step 7: Sign here
Under penalties of perjury, I state that, to the best of my knowledge, this return is true, correct, and complete.
_________________________________
(____)________________ __ __ / __ __ / __ __ __ __
Check this box if we may
Signature
Daytime telephone number
Month
Day
Year
discuss this return with the
preparer shown in this step.
___________________________________(____)________________ __ __ / __ __ / __ __ __ __
Name of Preparer (Please print)
Daytime telephone number
Month
Day
Year
NS
DR
ILLINOIS DEPARTMENT OF REVENUE
Mail to:
PO BOX 19016
IL-941-X Page 1 (R-12/14)
SPRINGFIELD IL 62794-9016
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