Illinois > Secretary Of State > Department Of Revenue
Owner Officer And General Partner Information Schedule REG-1-O - Illinois
| Owner Officer And General Partner Information Form. This is a Illinois form and can be used in Department Of Revenue Secretary Of State . |
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Illinois Department of Revenue Schedule REG-1-O Owner and Officer Information Mail your completed Schedule REG-1-O to: Central Registration Division, Illinois Department of Revenue, PO Box 19476, Springfield, IL 62794-9476 Read this information first - First time registrants - Attach this schedule to Form REG-1. If your organization is a: Proprietorship Partnership Corporation or S Corp Trust or estate Not-for-profit organization Limited liability company Governmental unit then complete Step 2 to identify: -- the owner (if husband/wife or civil union, enter both individuals' information) -- each general partner -- the president, secretary, and treasurer -- each trustee or executor -- the president, secretary, or treasurer -- each manager and member -- one contact person (for example, the liaison) Step 1: Identify your business or organization Business name: _________________________________________ Contact information for person completing this schedule: Name: _________________________________________________ FEIN: SSN: ______ - __________________ _________ - ______ - ____________ (Proprietorship only) Phone: (______) ______ - ____________ Step 2: Identify your owners and officers 1 Individuals - For each individual required, complete the following information (including the Social Security number). a ___________________________________ Name _________________ Title c ___________________________________ Name _________________ Title ______________________________________________________ Home address - No PO Box number City State ZIP ______________________________________________________ Home address - No PO Box number City State ZIP ____ / ____ / ________ Date of birth (______) ______ - ________ Phone ____ / ____ / ________ Date of birth (______) ______ - ________ Phone _______ - _____ - _________ Ownership percentage: ______ Social Security number _______ - _____ - _________ Ownership percentage: ______ Social Security number b ___________________________________ Name _________________ Title d ___________________________________ Name _________________ Title ______________________________________________________ Home address - No PO Box number City State ZIP ______________________________________________________ Home address - No PO Box number City State ZIP ____ / ____ / ________ Date of birth (______) ______ - ________ Phone ____ / ____ / ________ Date of birth (______) ______ - ________ Phone _______ - _____ - _________ Ownership percentage: ______ Social Security number _______ - _____ - _________ Ownership percentage: ______ Social Security number 2 Businesses - For each business that is an owner, complete the following information (including the federal employer identification number (FEIN)). a ___________________________________ ____-_____________ Name FEIN c ___________________________________ ____-_____________ Name FEIN ______________________________________________________ Legal address ______________________________________________________ Legal address ______________________________________________________ City State ZIP ______________________________________________________ City State ZIP (______) ______ - ________ Phone Ownership percentage: ______ (______) ______ - ________ Ownership percentage: ______ Phone b ___________________________________ ____-_____________ Name FEIN d ___________________________________ ____-_____________ Name FEIN ______________________________________________________ Legal address ______________________________________________________ Legal address ______________________________________________________ City State ZIP ______________________________________________________ City State ZIP (______) ______ - ________ Ownership percentage: ______ Phone (______) ______ - ________ Ownership percentage: ______ Phone Schedule REG-1-O (R-07/12) American LegalNet, Inc. www.FormsWorkFlow.com
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