OFFICE OF THE ILLINOIS STATE TREASURER 

            ESTATE TAX PAYMENT FORM
            Send this completed form, along with your payment, to the following address: 

                         Illinois State Treasurer's Office
                                  Attn: Estate Tax Section
                         1 East Old State Capitol Plaza
                                          Springfield, IL 62701

            Checks must be made payable to:  ILLINOIS STATE TREASURER 

 We accept Check, Money Order, Cashier's Check and ACH.  WE DO NOT ACCEPT CASH. 

            Payments may also be made in person at the following locations*: 
Illinois State Treasurer's Office                              Illinois State Treasurer's Office 
1 East Old State Capitol Plaza                                 555 West Monroe, 14th Floor
 Springfield, IL 62701                                               Chicago, IL 60661

*As of March 6, 2023, appointments must be scheduled in advance for any payments made in
 person at the Chicago address listed above.  To request an appointment, please contact
                         estatetax@illinoistreasurer.gov.

 For ACH instructions, or any other questions, please call our Toll Free Number: 1-800-252-8919 
To be completed by Estate Representative: 

DECEDENT NAME: _____________________________DATE OF DEATH: _____________________________ 

DECEDENT SSN: __________________________    COUNTY OF ASSESSMENT: ____________________ 

AMOUNT OF PAYMENT: $ ______________________ 

NAME AND ADDRESS OF PERSON TO RECEIVE PAYMENT RECEIPT: 

NAME, PHONE NUMBER AND E-MAIL ADDRESS OF CONTACT PERSON FOR ESTATE: 

To be completed by staff (in-person only):  To be completed by Springfield Estate Tax staff: 

                                            Mailed/Credit      Date: 
Date Stamp: 
                                            Payment Received: $ 
                                            Check/Money Order/ 
                                            Cashier's Check/ 
                                            ACH Number: 
                                            Date Stamp: 
Received By: ________________________