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Illinois Department of Revenue
Schedule UB
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Enter your name as shown on the tax return of the member filing the Schedule UB.
Enter your federal employer identification number.
Step 5 — Provide your affiliated company information
A
B
C
Reason for exclusion (
)
check one
Name
FEIN
80/20 company
non-combination rule
not unitary
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Schedule UB (R-12/15)
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