Form Il-1065-X - Amended Partnership Replacement Tax Return - 2015 Page 5

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Illinois Department of Revenue
*530802110*
Schedule B
2015
Enter your name as shown on your Form IL-1065 or Form IL-1120-ST.
Enter your federal employer identification number (FEIN).
Section B:
Members’ information
(See instructions before completing.)
A
B
C
D
E
F
G
H
I
J
Subject to
Member’s
Excluded
Share of
Partner
Illinois
distributable
from
Illinois income
Pass-through
Pass-through
or
SSN
replacement
amount
pass-through
subject to
withholding
Distributable
withholding
Shareholder
or
tax or an
of base
withholding
pass-through
before
share of
payment
Name and Address
type
FEIN
ESOP
income or loss
payments
withholding
credits
credits
amount
(If Column F is blank, complete Column G through Column J. Otherwise, enter zero
1
in Column G through Column J.)
Name
C/O
Addr. 1
Addr. 2
City
State
Zip
2
Name
C/O
Addr. 1
Addr. 2
City
State
Zip
3
Name
C/O
Addr. 1
Addr. 2
City
State
Zip
4
Name
C/O
Addr. 1
Addr. 2
City
State
Zip
5
Name
C/O
Addr. 1
Addr. 2
City
State
Zip
If you have more members than space provided, attach additional copies of this page as necessary.
Schedule B back (R-12/15)
Page 5 of 5
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