Employer'S Expense Tax Return Form (Page 2 of 4) in pdf

A C C O U N T N U M B E R

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5th

Month

6th Month

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I I

Enter the total number of personnel whowork

or perform services for your business in the

State of Illinois regardless of whether FICA or

Federal Income Tax is withheld,

7th

Month

8th

Month

II.

Enter the number of personnel in each ofthe

following categories. Failure to disclose or

complete this schedule will be deemed an

incomplete filing, pursuant to regulation.

Newspaper carriers under 18 years of age

Employees of non-profit organizations

Individuals employed by a qualifying relative

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e .

Other:

Number of employees or commission

merchants who earn or accrue less Ihan $900

in the quarter (the $900 includes but is

not

limited to the following: wages, vacalion, sick

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pay, bonus, tips, etc.

Number of employees who earn or accrue $900

or more in the quader and spend less Ihan 50%

of their working hours per calendar quarter

the City of Chicago.

............ ! ...... i ............... ........ : .................. !

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i ..... i ............. • ......................................... i ................................ i ...................

Total exempt employees (add a through f)

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Part III.

Line 1.

Total number of non-exempt employees of

employees (subtract Part IIg from Part 1).

Enter below each monthly amount from

Part III which equals or exceeds 50. For

any monthly amount in Ill which has less

than 50, enter 0 for that month below.

This amount should also be entered

Line I on this return,

7540022

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Employer'S Expense Tax Return Form Page 2

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