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         Illinois Department of Revenue

         CBS-1 Notice of Sale, Purchase, or Transfer of Business Assets

                                              • Complete this form in its entirety. 
                                              • Type or print clearly. 
                                              • Read Form CBS-1 Instructions for additional information. 

Step 1:  Identify the business, business assets, or business property being sold or transferred

  1 ____________________________________________________                  3   _______________________________________ 
    Business name
                                                                              Illinois business tax number (IBT no.) or account identification number

 2 ____________________________________________________                   4   ___ ___-___ ___ ___ ___ ___ ___ ___                                                                                                                         ___ ___ ___
    Street address                                                            Federal employer identification number (FEIN)                                                                                                                Seq. number
                 
                                                                          5 ___ ___ ___-___ ___-___ ___ ___ ___
    ____________________________________________________                      Social Security number
    Street address (if needed)
                                                                            6  Is the selling entity a disregarded entity?                                                                                                          Yes   No    
                                                                              If yes, provide the Illinois Account ID number of the entity                                                                                                                                
    ____________________________________________________ 
    City                            State               ZIP                   responsible for filing with the Illinois Department of Revenue.
                                                                              ________________________________________________
Step 2:  Identify the seller or transferor 

 7   ___________________________________________________                 10   ___________________________________________________
    Name                                                                      Name of seller’s or transferor’s attorney

 8   ___________________________________________________                 11  ___________________________________________________ 
    Home or current mailing address                                           Attorney’s mailing address
    ___________________________________________________                       ___________________________________________________
    City                                  State         ZIP
                                                                              ___________________________________________________
 9   _______________________     (         ) _________________________        City                                     State                                                                                                       ZIP
     Daytime phone number                  email address
                                                                         12  (        _______________________    )     __________________________
                                                                              Attorney’s daytime phone number          Attorney’s email address

Step 3:  Identify the purchaser or transferee 

  13 ___________________________________________________                 17  ___________________________________________________ _
    Name                                                                      Name of purchaser’s or transferee’s attorney
                                                                          
14   ___________________________________________________                 18   ____________________________________________________
    Current mailing address                                                   Attorney’s mailing address
    ___________________________________________________                       ____________________________________________________ 
    City                            State               ZIP
                                                                          
                                                                              ____________________________________________________
15  _______________________   (         ) ___________________________         City                                     State                                                                                                       ZIP
     Daytime phone number           email address
                                                                         19  (        _______________________    )     ___________________________
16   ___________________________________________________                      Attorney’s daytime phone number          Attorney’s email address
    Purchaser or transferee’s IBT no. and FEIN
Step 4:  Describe the terms of sale or transfer 
20   Date business will be sold                        ____/____/______  24  Terms of sale or transfer. Put an “X” in the appropriate box and    
                                                       month day year
                                                                             provide additional information as requested.
21  Selling price of the business or the value of the business assets           Cash sale
    transferred.  $____________________                                         Contract sale. Complete the following information
22   Was the entire business sold or transferred? (If no, provide a            • Down payment amount                   $_________________
    description of what is being sold.)                                        • Monthly payment amount                $_________________
      Yes                                                                      • Date last payment is due              ____/____/______                                                                                                                                   
      No ______________________________________________                                                                month                                                                                              day      year
                                                                                Conventional financing
23  Are the seller’s or transferor’s registration numbers shown on       
                                                                                Other (specify)  ____________________________________   
    Line 3 to remain active with IDOR? If no, provide the date to be    
                                                                               _________________________________________________
    discontinued.      Yes           No   ___/____/______
                                             month day year
                      This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. You are required to report all sales of businesses to the Illinois Department of Revenue. Printed by the authority of the State 
CBS-1 (R-01/19) front Disclosure of this information is REQUIRED. Failure to provide such information may result in the purchaser or transferee becoming personally liable for the amount of tax owed by the seller.               of Illinois. web only, 1 copy

Step 5:  List any additional persons to whom we must send a copy of the bulk sales correspondence 
 If you need to list more than four persons in this step, attach an additional sheet following the same format for each.

25  ____________________________________________________                    27  ____________________________________________________
   Name                                                                        Name
    ____________________________________________________                        ____________________________________________________
   Home or mailing address                                                     Home or mailing address
    ____________________________________________________                        ____________________________________________________
   City                                    State                 ZIP              City                               State        ZIP
   _______________________    (         ) __________________________           _______________________    (         )__________________________
   Daytime phone number                   Email address                        Daytime phone number                  Email address

   Check one to show association with:      Seller                Purchaser       Check one to show association with:  Seller      Purchaser

26  ____________________________________________________                    28  ____________________________________________________
   Name                                                                        Name
    ____________________________________________________                        ____________________________________________________
   Home or mailing address                                                     Home or mailing address
    ____________________________________________________                        ____________________________________________________
   City                                    State                 ZIP              City                               State        ZIP
   _______________________    (         ) __________________________           _______________________    (         )__________________________
   Daytime phone number                   Email address                        Daytime phone number                  Email address

   Check one to show association with:      Seller                Purchaser     Check one to show association with:    Seller      Purchaser

Step 6:  Identify yourself (the person submitting the form) 

 29  ____________________________________________________ 
   Your name
30 ____________________________________________________  
   Your mailing address   
     ____________________________________________________
   City                                    State                 ZIP

31 (         )______________________     ___________________________
   Daytime phone number    Email address
Step 7:  Submit completed form
Attach a copy of the financing agreement (if requested), and a copy of the following from the sales contract to Form CBS-1:
 •  Page(s) identifying the business, assets, and/or property being sold
 •  Page(s) identifying the purchase price
 •  Page(s) identifying how payment is to be made
 •  Signatures of the purchaser or transferor and seller or transferer
Submit Form CBS-1 by 
 •  completing the form on our website and clicking the “Submit” button at the bottom of the page*
 •  emailing the form to REV.bulksales@illinois.gov
 •  faxing the form to  217 785-2635                                                   *           If you have an email address linked to your 
                                                                                       web browser, you should submit Form CBS-1 by using 
 •  mailing the form to    BULK SALES UNIT                                             the “Submit” button at the bottom of the form on our 
                           ILLINOIS DEPARTMENT OF REVENUE                              website. If you do not have an email account linked to 
                           P.O. BOX 19035                                              your web browser, save the form and send it as an email 
                           SPRINGFIELD IL  62794-9035                                  attachment.

CBS-1 (R-01/19) back                             Reset                      Print         Submit