Employer'S Expense Tax Return Form (Page 3 of 4) in pdf

Employer'S Expense Tax Return Form Page 3

A C C O U N T NUMBER

Enter the total number of personnel who work

or perform services for your business in the

State of Illinois regardless of whether FICA or

Federal Income Tax is withheld.

II.

Enter the number of personnel in each of the

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

d o

e .

Other:

Number of employees or commission

merchants who earn or accrue less lhan $900

in the quarter (the $900 includes but is not

limited to the following: wages, vacation, sick

pay, bonus, tips,

etc.

Number of employees who earn or accrue $900

or more in the quarter and spend less Ihan 50%

of their working hours per calendar quarter in

the City of Chicago.

Total exempt employees (add a through l)

Pad Ill.

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 III which has less

than 50, enter 0 for that month below.

This amount should also be entered on

Line 1 on this return.

9th Month

10th Month

11th Month

12th Month

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7540023

Page

Rev 008 0612

Employer'S Expense Tax Return Form Page 3

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