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Illinois Department of Revenue
BOA-1 Board of Appeals Petition Docket number: ________________________
Step 1: Identify yourself (and spouse, if applicable) B If business debt, identify your business or organization
A ___ ___ ___ - ___ ___ - ___ ___ ___ ___ ___ ___ - ___ ___ ___ ___ ___ ___ ___
Your Social security number Federal employer identification number (FEIN)
___ ___ ___ - ___ ___ - ___ ___ ___ ___ ___ ___ ___ ___ - ___ ___ ___ ___
Your spouse’s Social security number Illinois account ID
__________________________________________________
Your first name and middle initial Last name Legal business name: ________________________________
_________________________________________________________________ Doing-business-as (DBA), assumed, or trade name, if different
Your spouse’s first name and middle initial Last name from the legal business name on the line above:
_________________________________________________________________
Street address - No PO Box number Apartment or suite number __________________________________________________
_________________________________________________________________ __________________________________________________
City State ZIP Business mailing address
_________________________________________________________________ __________________________________________________
Your email address City State ZIP
(_____)______________ (_____)______________ __________________________________________
Your home phone number Your work phone number Contact person
(_____)______________ (_____)______________ (_____)______________ _________________________
Your mobile phone number Your spouse’s phone number Phone number Email address
Step 2: Complete this step if you are being represented by someone else
1 Attach a completed Form IL-2848, Power of Attorney, to your completed Form BOA-1.
2 Identify each representative you appointed as attorney-in-fact (Step 3 of your Form IL-2848, Power of Attorney).
________________________________________________________________ ________________________________________________________________
Name of individual Name of firm (if applicable)
________________________________________________________________ ________________________________________________________________
Name of individual Name of firm (if applicable)
Step 3: Provide the following information
3 Identify the tax type for which you are requesting relief and specify the liability period(s) for each tax type. Provide your
Illinois Account ID number for each tax type. (If the tax type is individual income tax, this is your Social security
number.) If there are multiple businesses, complete a separate petition for each active business.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
4 If the debt is due to an NPL or 1002D personal liability penalty, write the penalty number.
___________________________________________________________________________________________
5 Complete Line a or b to tell us why you are filing this petition and provide requested documentation.
a My petition is to request abatement of penalty and/or interest based on reasonable cause (Reasonable
Cause petition). If the Board of Appeals determines that additional financial information is required, we will
notify you.
Write the amount of relief requested. Penalty $_______________________ Interest $___________________
b My petition is to request a compromise of my liability due to reasons of financial hardship (Offer in Compromise
petition). You must provide the required documentation (see instructions below).
Write the amount of your best possible offer. $_______________________________________
Attach complete copies of the following: 1) your last three federal income tax returns and all schedules; 2) your
last three state income tax returns and schedules; 3) bank statements and brokerage statements from all of
your financial institutions summarizing the last six months’ activities; and 4) current financial statement(s) - for
individuals, your last two paycheck stubs and a completed Form BOA-4, Financial Information for Individuals,
or for businesses, a completed Form BOA-5, Financial Information for Businesses.
Printed by the authority of the state of Illinois - electronic only, one copy 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
BOA-1 (R-03/23) Page 1 of 3 information is REQUIRED. Failure to provide information may result in this form not being processed and may result in a penalty.
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