Form Il-1023-C - Composite Income And Replacement Tax Return - 2011 Page 3

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Illinois Department of Revenue
Year ending
Composite Return
Schedule BC
____ ____
Month
Year
Membership
Attach to your Form IL-1023-C
IL Attachment no. 1
Write your
Write your name as shown on your Form IL-1023-C.
federal employer identification number (FEIN).
_____________________________________________________________
___ ___ - ___ ___ ___ ___ ___ ___ ___
Identify the members included in your composite return
A
B
C
D
E
F
Check the box if the
Pass-through
Partner or
member is an Illinois resident
entity payment
Social Security number
Shareholder type Share of income
and is included based on
amount.
Name and Address
or FEIN
(See instructions.)
or loss (%)
department-approved petition. (See instructions.)
1
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
2
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
3
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
4
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
5
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
6
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
7
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
8
________________________________
________________________________
________________________________
________________________________ _________________
______
_________
______________
*130901110*
Schedule BC (R-12/11)
Reset
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