Form Il-941 - Illinois Withholding Income Tax Return - 2012
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Illinois Department of Revenue
Form IL-941
2012
Illinois Withholding Income Tax Return
Step 1: Provide your information
Reporting Period
If you are a quarterly filer:
0
0
0
Check this
_ __ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___
Check the quarter you are reporting.
box i f this is
Federal employer identification number (FEIN)
Seq. number
your first
1st
(January, February, March)
return.
____________________________________________________________
2nd
(April, May, June)
Business name
Check this
box if your
____________________________________________________________
business
3rd
(July, August, September)
name has
C/O
changed.
4th
(October, November, December)
_ ___________________________________________________________
If you are an annual filer:
Check this
box if your
Mailing address
Check the box if you are not required to file quarterly.
address
has
_ _____________________________ _______ __________________
January — December
changed.
City
State
ZIP
Step 2: Tell us about your W-2 forms and your business
A
Write the total number of W-2 forms you were required to issue for the entire year.
A
__________________
(Quarterly filers — Only complete this line when you file your 4th quarter or final return.)
B
If your business has permanently stopped withholding because it has c losed or you no longer
B
pay wages, c heck the box and write the date you s topped paying wages.
__ __ / __ __ / 2012
Month Day
Step 3: Tell us your payroll information
1
Write the total compensation and gambling winnings (including Illinois Lottery winnings)
1
__________________
subject to withholding this period.
Step 4: Tell us about your withholding for this period
2
2 __________________
Write the amount of Illinois Income Tax actually withheld for this period.
Step 5: Tell us about your payments and credits
3
Write the total amount of withholding payments you have made during this
3 ________________
period. This includes all IL-501 payments (electronic and paper coupons).
4
4 ________________
Write the amount of credit carried forward from your previous Form IL-941.
5
5 ________________
Write the total amount of credits you have received through DCEO.
6
6
__________________
Add Lines 3, 4, and 5 and write the total amount here.
Step 6: Figure your credit or the amount you owe
7
If Line 2 is greater than Line 6, subtract Line 6 from Line 2. This is your remaining
balance due. Make your payment electronically (semi-weeklys must pay electronically)
7 __________________
or make your remittance payable to “Illinois Department of Revenue.”
8
8 __________________
If Line 2 is less than Line 6, subtract Line 2 from Line 6. Claim this amount on your next Form IL-941.
Step 7: Sign here
Under penalties of perjury, I state that, to the best of my knowledge, this return is true, correct, and complete.
______________________________________________ (____)________________
__ __ / __ __ / __ __ __ __
Signature
Daytime telephone number
Month Day
Year
ILLINOIS DEPARTMENT OF REVENUE
Mail to:
NS DR
PO BOX 19052
IL-941 (R-12/11)
SPRINGFIELD IL 62794-9052
271001110
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