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Illinois Department of Revenue
ST-586 Annual Certification of No Solicitation
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Individuals, organizations and corporations must complete Form ST-586, Annual Certification of No Solicitation, to certify under
penalty of perjury that they have not engaged in any prohibited solicitation activities in Illinois at any time during the previous
year.
Step 1: Identify the Individual, Organization or Corporation
Please check one: r Individual (Complete Steps 1 and 2) r Organization/Corporation (Complete Steps 1, 2 and 3)
Individual’s Name____________________________________________________ Title__________________________
Organization/Corporation_______________________________________________ FEIN _________________________
Address__________________________________________ _________________________________________________
Street address (no P.O. Box) City State ZIP
Step 2: Annual Certification of No Solicitation
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY:
That the individual, organization or corporation listed above is operating under an agreement with _______________________
Out-of-State Retailer’s Name
and the person, organization or corporation named above has not engaged in prohibited solicitation activities in Illinois that refer
potential customers to _____________________________________________ at any time during the previous year ___________to
Out-of-State Retailer’s Name MM-DD-YYYY
___________. The prohibited solicitation activities include, but are not limited to, distributing flyers, coupons, newsletters, and
MM-DD-YYYY
other printed promotional materials or electronic equivalents, verbal soliciting (e.g., in-person referrals), initiating telephone calls,
and sending emails or text messages.
Print Name____________________________________________________
Individual or an Officer of the organization or corporation listed above
Signature ________________________________________________________ Date______________________
Signature of person’s name printed above
Step 3: Additional Statement Required from Organization or Corporation
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY:
That the website of the organization or corporation listed above includes information that alerts its members that anyone operating
under the organization’s/corporation’s agreement with ________________________________________ is prohibited from
Out-of-State Retailer’s Name
engaging in any solicitation activities in Illinois that refer potential customers to ________________________________, including,
Out-of-State Retailer’s Name
but not limited to, distributing flyers, coupons, newsletters, and other printed promotional materials or electronic equivalents, verbal
soliciting (e.g., in-person referrals), initiating telephone calls, and sending emails or text messages.
Print Name____________________________________________________
Officer of the organization or corporation listed in Step 1
Signature ________________________________________________________ Date______________________
Signature of person’s name printed above
Printed by authority of the State of Illinois
web copy only ST586 front (N-10/16)
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