Illinois Payment Voucher for Amended Fiduciary Income and Replacement Tax

Payment Voucher for Amended Fiduciary Income and Replacement Tax
IL-1041-X-V, Payment Voucher for Amended Fiduciary Income and Replacement Tax
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.

To pay the amount you owe, complete the following steps:
1.	 Enter your federal employer identification number (FEIN).
2.	 Enter your name, C/O information (if applicable), address, and phone number.
3.	 Enter the month and year your tax year ends.
4.	 Enter the amount you are paying. Use whole dollars only.
5.	 Detach the voucher and enclose a check or money order for the amount you are paying.
•	 Write your FEIN, tax year ending, and “IL-1041-X-V” on your payment.
•	 Make your check or money order payable to “Illinois Department of Revenue.”
•	 Attach your completed voucher and payment to your amended return, and mail them
to the address shown on the voucher.
Printed by the authority of the state of Illinois - electronic only - one copy.

			
Illinois Department of Revenue

	IL-1041-X-V

		

	
IL-1041-X-V (R-12/23)

	

	

Mail to: Illinois Department of Revenue, P.O. Box 19016, Springfield, IL 62794-9016

	

	

Payment Voucher for
		 Amended Fiduciary
Income
and Replacement Tax
	

			
Official use only

	 If no payment
is due or you make your payment electronically, do not file this form.
	

	

		
FEIN: 	

	

	

Tax year ending

				
					
		

	
	
								
	
Month
Year
	Name:	
		
	
		
			
	
		
	
	
	
	

00

$
	
	
C/O:	
Payment
Amount (Whole dollars
only)
		
	
		
Mailing														
Write
your
FEIN,
tax
year
ending,
and
“IL-1041-X-V”
on
your check or
address: 	
			
money order and make it payable to “Illinois Department of Revenue.”

City:		

	Phone:

(

State:
)

ZIP:

Reset

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