Illinois > Secretary Of State > Department Of Revenue
Responsible Party Information Schedule REG-1-R - Illinois
| Responsible Party 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-R Responsible Party Information FEIN: SSN: ______ - __________________ (Proprietorship only) Attach to Form REG-1 or fax to us at 217 785-6013. Business name: _________________________________________ Contact for this schedule: __________________________________ Phone: (__ __ __) ___ ___ ___ - ___ ___ ___ ___ _________ - ______ - ____________ Read this information first. Complete this schedule and attach it to Form REG-1, Illinois Business Registration Application, to identify the person(s) who will be responsible for filing returns and paying taxes due. If you need to identify more, attach a separate sheet using a similar format. Step 1: Identify the person(s) responsible for filing your business' returns and paying all tax due Printed legal name:_______________________________________ Legal address: __________________________________________ Check all for which you are responsible: SSN: _________ - ______ - ____________ Phone: (_____) ______ - ___________ Sales and use taxes and fees Motor vehicle renting tax Withholding income tax Motor fuel and related taxes All taxes and fees Excise taxes and fees- Identify tax/fee: _____________________________ Other: __________________________________________________________ Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete. I further attest that I will be responsible for filing returns and paying the taxes indicated. Signature: ______________________________________________ Title: ______________________ Date:___/___/______ If you need to identify another person, complete the following: Printed legal name:_______________________________________ Legal address:__________________________________________ Check all for which you are responsible: SSN: _________ - ______ - ____________ Phone: (_____) ______ - ___________ Sales and use taxes and fees Motor vehicle renting tax Withholding income tax Motor fuel and related taxes All taxes and fees Excise taxes and fees- Identify tax/fee: _____________________________ Other: __________________________________________________________ Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete. I further attest that I will be responsible for filing returns and paying the taxes indicated. Signature: ______________________________________________ Title: ______________________ Date:___/___/______ If you need to identify another person, complete the following: Printed legal name:_______________________________________ Legal address:__________________________________________ SSN: _________ - ______ - ____________ Phone: (_____) ______ - ___________ Sales and use taxes and fees Motor vehicle renting tax Withholding income tax Motor fuel and related taxes All taxes and fees Excise taxes and fees- Identify tax/fee: _____________________________ Other: __________________________________________________________ Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete. I further attest that I will be responsible for filing returns and paying the taxes indicated. Signature: ______________________________________________ Title: ______________________ Date:___/___/______ Schedule REG-1-R (R-04/10) American LegalNet, Inc. www.FormsWorkFlow.com
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