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This application is New Revised Illinois Department of Revenue IL-8633-I Application to File Illinois Individual Income Tax Returns Electronically Mail to: Electronic Commerce Division, Illinois Department of Revenue, P.O. Box 19479, Springfield, IL 62794-9479 for Software Developers An assigned Internal Revenue Service (IRS) Electronic Filer Identification number (EFIN) and an IRS Electronic Transmitter Identification number (ETIN) are required to complete Form IL-8633-I. We will not process Form IL-8633-I without both the IRS identification numbers. If any of the information you provide below changes after you submit your Form IL-8633-I, you must complete and submit a "Revised" Form IL-8633-I to update your information. Step 1: Complete the following information 1 _________________________________________________ Legal name of business (as shown on tax return) 6 __________________________________________________ Federal employer identification number (FEIN) or Social Security number (SSN) 2 _________________________________________________ 7 __________________________________________________ Doing business as (dba) name (if different than Line 1) Primary contact representative Ext.: 3 _________________________________________________ __________________________________________________ Business street address Daytime phone - include area code _________________________________________________ City State FAX number and area code 8 __________________________________________________ ZIP Alternate contact representative Ext.: 4 _________________________________________________ __________________________________________________ Mailing address (if different than above) Daytime phone - include area code FAX number and area code _________________________________________________ City State ZIP 5 _________________________________________________ Business e-mail address Step 2: Provide your EFIN and ETIN EFIN: ___ ___ ___ ___ ___ ___ 9 ETIN: ___ ___ ___ ___ ___ Step 3: Sign below - Signature is required for both new and revised applications Under the penalties of perjury, I state that I have examined this form and, to the best of my knowledge it is true, correct, and complete. I state that this business will comply with all the provisions of the program, that acceptance for participation is not transferable, and that noncompliance will void participation in the program. I am authorized to make and sign this statement on behalf of the business. ___________________________________________________ ____________________________________________________ Name and title of official or principal owner of the business (Please print.) SSN of an official or principal owner of the business ___________________________________________________ ____________________________________________________ Signature of the official or principal owner of the business Date IL-8633-I (R-12/12) This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is required of those taxpayers to whom this form applies. Failure to provide this information when required could result in a penalty. This form has been approved by the Forms Management Center. IL-492-2742 RESET PRINT IL-8633-I Instructions General Information Who must submit this application? Any business that devleops electronic return formatting software must submit Form IL-8633-I, Application to File Illinois Individual Income Tax Returns Electronically for Software Developers, to participate in the Illinois Individual Income Tax Electronic Filing Program. If any of the information you provide changes after you submit your Form IL-8633-I, you must complete and submit a "Revised" Form IL-8633-I, to update your information. This includes any business that is sold or changes its organizational structure. CAUTION: Electronic Return Originators (EROs), DO NOT submit Form IL-8633-I, or send a copy of the IRS 8633, or the IRS acceptance letter. EROs that are registered in the IRS Electronic Filing Program, and are in good standing, are automatically registered in the Illinois program. Where should I mail the application? ELECTRONIC COMMERCE DIVISION ILLINOIS DEPARTMENT OF REVENUE PO BOX 19479 SPRINGFIELD IL 62794-9479 What if I have questions? If you have questions, write us at Electronic Commerce Division, Illinois Department of Revenue, PO Box 19479, Springfield, Illinois 62794-9479; or call our Springfield office weekdays between 8 a.m. and 4 p.m. at 217 524-4767. You can also visit our Web site, which features electronic filing information, forms, and booklets at tax.illinois.gov. Step-by-Step Instructions Step 1: Complete the following information Step 2: Provide your EFIN and ETIN Line 1 - Write the legal name of your business (as shown on your tax return). Line 9 - Write your EFIN and ETIN. You must have a valid EFIN and ETIN that has been assigned and approved by the IRS. Line 2 - If, for the purpose of electronic filing, your business uses any name other than the name on Line 1, write that name. Line 3 through 5 - Follow the instructions on the form. Line 6 - If you are a partnership or corporation, write your federal employer identification number (FEIN). Sole proprietors without a FEIN, write your Social Security number (SSN). Lines 7 and 8 - Provide the name, daytime phone and FAX (including area code) of your primary and alternate contact representatives. Note: It may be necessary to contact your business during testing and throughout the processing year. IL-8633-I (R-10/10) Step 3: Sign below Signature is required for both new and revised applications. Read the applicant’s agreement and provide the name, title, and SSN of the person who is authorized to act and sign for your business in legal or tax matters. Also, sign and date the application. All applications must have an original signature and date. We will not accept a photocopy of a signature.