Page 1 of 1

Read this information first

• Form ITR-1 will not be processed until all returns are filed and balances paid (including penalty and interest, if applicable).

• Allow at least 10 business days for processing of Form ITR-1.

• If you are selling or have sold your business assets, do not complete Form ITR-1, Request for Tax Clearance. You must complete

Form CBS-1, Notice of Sale or Purchase of Business Assets.

• If you need assistance in completing Form ITR-1, you can contact us at 1 800 732-8866 or at the address listed below.

Note: By completing the email address fields below, you are authorizing the Illinois Department of Revenue to send confidential information

through internet email. Internet email replies from the Illinois Department of Revenue are not binding on the Department and create no rights

under the Taxpayer Bill of Rights. The Illinois Department of Revenue assumes no liability for lost, eavesdropped, or otherwise misused

information provided in the email. Please refer to the Department’s Privacy Policy for additional information.

Step 1: Identify yourself or your business

1 Name:_________________________________________________________________________________________________________

2 Doing business as (DBA):______________________________________ 10 Do you make retail sales in Illinois? yes no

3 Street address: ______________________________________________ 11 Do you maintain an office in Illinois? yes no

City, state, ZIP: ______________________________________________ 12 Do you have employees in Illinois? yes no

4 Telephone (include area code): (______)______-__________ 13 If this tax clearance is to be sent to a third party, provide the

following:

5 Federal Employer Identification number (FEIN): __ __-__ __ __ __ __ __ __ Name: ________________________________________

6 Illinois Account ID: __ __ __ __-__ __ __ __ In-care-of name: ________________________________

7 Social Security number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ Address:_______________________________________

8 Excise Tax License number:_______________________________ City, state, ZIP:__________________________________

9 Date business started in Illinois :_____/_____/_____ E-mail Address: _________________________________

Step 2: Check the taxes for which you are requesting tax clearance

Business Income Tax Retailers’ Occupation Tax (including sales and use taxes)

Withholding Income Tax Hotel/Motel Tax

Individual Income Tax Automobile Renting Tax

Vehicle Use Tax Excise Tax. Specify: ____________________________

Step 3: Check the reason you are requesting tax clearance

Real estate transaction Required by a state other than Illinois

Bank closing License renewal required by another agency

DCEO incentive. Please explain: _________________________________________________________________________________

Other. Please explain:__________________________________________________________________________________________

Step 4: Sign below

An owner or officer of the business requesting the tax clearance must complete this step. Signature stamps are not acceptable.

Note: If you have been appointed as power of attorney for the taxpayer requesting this tax clearance, you must attach a copy of your power of

attorney that specifically states your authorization in tax related situations. See Form IL-2848, Power of Attorney.

Sign:_________________________________________ _____/_____/_____ Print title: __________________________________________

Print name:___________________________________________________ E-mail Address: _____________________________________

Step 5: Send your request

Mail to: PROBLEMS RESOLUTION DIVISION Or email to: rev.prd@Illinois.gov

ILLINOIS DEPARTMENT OF REVENUE

PO BOX 19014

SPRINGFIELD, IL 62704-9014

Note: This tax clearance does not preclude assessment for any liability for pending, current, or future taxes or liabilities that may be established

by present or future audits conducted by the department.

Illinois Department of Revenue

ITR-1 Request for Tax Clearance

Month Day Year

Number and street or post office box

Month Day Year Title (i.e., president, owner, partner, individual)

ITR‐1 (R-08/18)

This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information is REQUIRED.

Failure to provide information could result in the denial of your request. Printed by the authority of the State of Illinois-Web Only-1