Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.

                                                                          *77712191W*

       Illinois Department of Revenue
                                                                     Certificate of Exemption for 
     Form IL-1000-E                                                  Pass-through Withholding
                                 
Read this information first                                            In the event that we notify you that the certificate has been 
                                                                       revoked, the certificate remains valid for 60 days after the 
Owners:
                                                                       date of notification, and you must then begin withholding for 
Form IL-1000-E should be completed by any owner (partner,
                                                                       income distributable to the owner.
shareholder, or beneficiary) that elects to make its own tax
payments on income from a pass-through entity (partnership,            If the certificate has been revoked, you may not accept 
S corporation, or trust). Individuals may not make the                 another certificate from the owner until we notify you.
exemption election.                                                    Specific information for both owners and pass-through
Pass-through entities:                                                 entities:
In order to accept Form IL-1000-E, make sure that the                  Form IL-1000-E must only be completed, signed, and 
certificate is completed and signed by the owner, officer,             submitted once to the pass-through entity. It does not need to 
fiduciary, or authorized representative. Keep the certificates in      be resubmitted on an annual basis. 
your files. Do not send them to us unless we specifically              Do not send Form IL-1000-E to us unless we specifically 
request them from you.                                                 request it from you.

Step 1:  Identify the pass-through entity
The pass-through entity must keep this certificate.

                                                                     (           ) 
Name                                                                  Phone number

Mailing address 
                                                                     Federal employer identification number (FEIN)
City                      State                    ZIP

Step 2:  Identify the owner (partner, shareholder, or beneficiary)

Name

                                                                      Federal employer identification number (FEIN)
Mailing address 

                                                                     Check the box to indicate your business type:
City                      State                    ZIP
                                                                         Corporation
(           )                                                             Subchapter S corporation
Phone number                                                             Partnership
                                                                         Trust
                                                                         Estate

Step 3:  Sign below
I certify that the owner indicated in Step 2 will file all Illinois income tax returns and make timely payment of all Illinois income taxes 
due, and that it is subject to personal jurisdiction of the State of Illinois for purposes of the collection of income taxes due with 
respect to income from the partnership, corporation, or trust indicated in Step 1 of this certificate.

Signature of owner, officer, fiduciary, or authorized representative                                                   Date

Printed Name                                                                                                           Title
                                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. 

     IL-1000-E (R-12/19)                                                  Printed by the authority of the S tate of Illinois - web only - one copy.
                                Reset                                Print