Form REG-4-D Financial Institution Irrevocable Letter of Credit Bond - Illinois

Form REG-4-D is a Illinois Department of Revenue form also known as the "Financial Institution Irrevocable Letter Of Credit Bond". The latest edition of the form was released in April 1, 2013 and is available for digital filing.

Download a PDF version of the Form REG-4-D down below or find it on Illinois Department of Revenue Forms website.

Step-by-step Form 4-D instructions can be downloaded by clicking this link.

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Illinois Department of Revenue
REG-4-D
Financial Institution Irrevocable Letter of Credit Bond
Part 1: Financial institution letter of credit bond type and number
a
Bond type: _________________________________________________
b
Financial institution irrevocable letter of credit number: _______________
c
Bond amount: $_____________________
Part 2: Taxpayer and financial institution information
Taxpayer:
Financial institution:
_________________________________________ ________
_______________________________________________
Name
Name
_________________________________________ ________
_______________________________________________
Street address
Street address
_________________________________________ ________
_______________________________________________
City
State
ZIP
City
State
ZIP
Part 3: Effective and maturity date of bond
Effective date:
____ /____ /________
Maturity date:
____ /____ /________
Month
Day
Year
Month
Day
Year
Part 4: Bond conditions
If the taxpayer identified above, in Part 2, fails to pay the Illinois Department of Revenue (IDOR) all moneys, including
penalties and interest, due under this bond type's tax act, IDOR is authorized to draw drafts on demand against this
irrevocable letter of credit. The sum of the drafts drawn against this irrevocable letter of credit cannot exceed the bond
amount above, in Part 1, and drafts drawn against it are payable on demand. This letter of credit is issued for a period
of one year and will be renewed automatically for successive one-year periods unless IDOR receives a written notice of
cancellation 30 days prior to the maturity date.
Part 5: Financial institution officer information
The undersigned officer of the financial institution identified above, in Part 2, is duly authorized by the Board of Directors to
execute this irrevocable letter of credit; and this financial institution will honor all drafts on demand. The name of the authorized
financial institution officer, title, and signature are required.
Name: ___________________________________________
Title: __________________________________________
Signature: ________________________________________
Part 6: Financial institution seal
The official seal of the financial institution must be affixed below.
For official use only
Date approved: ____ /____ /________
______________________________________
Month
Day
Year
IDOR Director's signature
License number: _____________________
REG-4-D (R-04/13)
Illinois Department of Revenue
REG-4-D
Financial Institution Irrevocable Letter of Credit Bond
Part 1: Financial institution letter of credit bond type and number
a
Bond type: _________________________________________________
b
Financial institution irrevocable letter of credit number: _______________
c
Bond amount: $_____________________
Part 2: Taxpayer and financial institution information
Taxpayer:
Financial institution:
_________________________________________ ________
_______________________________________________
Name
Name
_________________________________________ ________
_______________________________________________
Street address
Street address
_________________________________________ ________
_______________________________________________
City
State
ZIP
City
State
ZIP
Part 3: Effective and maturity date of bond
Effective date:
____ /____ /________
Maturity date:
____ /____ /________
Month
Day
Year
Month
Day
Year
Part 4: Bond conditions
If the taxpayer identified above, in Part 2, fails to pay the Illinois Department of Revenue (IDOR) all moneys, including
penalties and interest, due under this bond type's tax act, IDOR is authorized to draw drafts on demand against this
irrevocable letter of credit. The sum of the drafts drawn against this irrevocable letter of credit cannot exceed the bond
amount above, in Part 1, and drafts drawn against it are payable on demand. This letter of credit is issued for a period
of one year and will be renewed automatically for successive one-year periods unless IDOR receives a written notice of
cancellation 30 days prior to the maturity date.
Part 5: Financial institution officer information
The undersigned officer of the financial institution identified above, in Part 2, is duly authorized by the Board of Directors to
execute this irrevocable letter of credit; and this financial institution will honor all drafts on demand. The name of the authorized
financial institution officer, title, and signature are required.
Name: ___________________________________________
Title: __________________________________________
Signature: ________________________________________
Part 6: Financial institution seal
The official seal of the financial institution must be affixed below.
For official use only
Date approved: ____ /____ /________
______________________________________
Month
Day
Year
IDOR Director's signature
License number: _____________________
REG-4-D (R-04/13)

Download Form REG-4-D Financial Institution Irrevocable Letter of Credit Bond - Illinois

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