Beruflich Dokumente
Kultur Dokumente
*932401110*
If you have an address change, or this is a first return, check this box.
__________________________________________________________
Name
__________________________________________________________
C/O
__________________________________________________________
Mailing address
__________________________________________________________
City
State
ZIP
Zip
check the appropriate box and see Special Apportionment Formula instructions. K If you have completed the following federal forms,
check the box and attach them to this return.
Financial organizations
Transportation companies
Federal Form 8886
Federal Sch. M-3
E Check if you are classified as an investment partnership.
1 _______________ 00
2 _______________ 00
3 _______________ 00
4 _______________ 00
5 Net IRC Section 1231 gain or loss from involuntary conversions due to casualty and theft.
5 _______________ 00
6 All other items of income or loss that were not included in the computation
of income or loss on Page 1 of U.S. Form 1065 or 1065-B. See instructions.
Identify:____________________________________________________
6 _______________ 00
7 _______________ 00
8 _______________ 00
9 _______________ 00
10 _______________ 00
11 All other items of expense that were not deducted in the computation
of ordinary income or loss on Page 1 of U.S. Form 1065 or 1065-B. See instructions.
Identify: ____________________________________________________________
11 _______________ 00
12 _______________ 00
13 Subtract Line 12 from Line 7. This amount is your total unmodified base income or loss.
13 _______________ 00
NS
DR_______
IL-1065 (R-12/09)
Page 1 of 4
14 _______________ 00
15 _______________ 00
16 _______________ 00
17 _______________ 00
18 _______________ 00
19 _______________ 00
20 _______________ 00
21 The amount of loss distributable to a partner subject to replacement tax. Attach Schedule B.
21 _______________ 00
22 _______________ 00
23 _______________ 00
24 _______________ 00
25 _______________ 00
26 _______________ 00
27 _______________ 00
28 _______________ 00
30 _______________ 00
31 _______________ 00
32 _______________ 00
33 _______________ 00
34 _______________ 00
35 _______________ 00
36 _______________ 00
If the amount on Line 36 is derived inside and outside Illinois, complete Step 6; otherwise go to Step 7.
37 _______________ 00
38 _______________ 00
39 _______________ 00
40 _______________ 00
41 _______________ 00
42 _______________ 00
._________________
44 _______________ 00
45 _______________ 00
46 _______________ 00
47 Base income or net loss allocable to Illinois. Add Lines 44 through 46.
47 _______________ 00
Page 2 of 4
*932402110*
IL-1065 (R-12/09)
*932403110*
48 Base income or net loss from Step 5, Line 36, or Step 6, Line 47.
48 _______________ 00
49 _______________ 00
50 _______________ 00
51 _______________ 00
52 Divide Line 48 by Line 51. (This figure cannot be greater than 1.)
52 ____ ____________
53 _______________ 00
54 _______________ 00
55 _______________ 00
56 _______________ 00
57 _______________ 00
58 _______________ 00
59 _______________ 00
60 Net replacement tax. Subtract Line 59 from Line 58. Write 0 if this is a negative amount.
60 _______________ 00
a _______________ 00
b _______________ 00
c _______________ 00
62 _______________ 00
63 Overpayment. If Line 62 is greater than Line 60, subtract Line 60 from Line 62.
63 _______________ __
64 _______________ 00
65 Refund. Subtract Line 64 from Line 63. This is the amount to be refunded.
65 _______________ __
66 Tax Due. If Line 60 is greater than Line 62, subtract Line 62 from Line 60.
66 _______________ __
Make your check payable to Illinois Department of Revenue and attach to the first page of this form.
Write the amount of your payment on the top of Page 1 in the space provided.
_____________________________________________
___/___/____
_________________________
(_____)__________
Signature of partner
Date
Title
Phone
_____________________________________________
___/___/____
____________________________________________
Signature of preparer
Date
_________________________________
________________________________________________
(_____)__________
Address
Phone
Mail this return to: Illinois Department of Revenue, P.O. Box 19031, Springfield, IL 62794-9031
IL-1065 (R-12/09)
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide information could
result in a penalty. This form has been approved by the Forms Management Center.
IL-492-0073
Page 3 of 4
*930801110*
Schedule B
Year ending
____ ____
Month
Year
IL Attachment no. 1
_____________________________________________________________
Write the amount of base income or net loss from your Form IL-1065 or Form IL-1120-ST, Line 48.
Write the apportionment factor from your Form IL-1065 or Form IL-1120-ST, Line 43.
1 ______________________
2 ____ _________________
SSN or FEIN
Partner or
Shareholder type
(See instructions.)
Total amount of
base income (loss)
distributable
(See instr.)
Member
subject to Illinois
replacement tax
(See instr.)
Pass-through
entity payment
amount
(See instr.)
Excluded from
pass-through
entity payments
(See instr.)
1 ________________________________
________________________________
________________________________
________________________________ ______________
______
_________________
______________
______
______
_________________
______________
______
______
_________________
______________
______
______
_________________
______________
______
______
_________________
______________
______
______
_________________
______________
______
_________________
2 ________________________________
________________________________
________________________________
________________________________ ______________
3 ________________________________
________________________________
________________________________
________________________________ ______________
4 ________________________________
________________________________
________________________________
________________________________ ______________
5 ________________________________
________________________________
________________________________
________________________________ ______________
6 ________________________________
________________________________
________________________________
________________________________ ______________
Schedule B (R-12/09)
Page 4 of 4
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