Form IL-8655 Reporting Agent Electronic Services Authorization - Illinois

Form IL-8655 is a Illinois Department of Revenue form also known as the "Reporting Agent Electronic Services Authorization". The latest edition of the form was released in December 1, 2017 and is available for digital filing.

Download a PDF version of the Form IL-8655 down below or find it on Illinois Department of Revenue Forms website.

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Illinois Department of Revenue
IL-8655
Reporting Agent Electronic Services Authorization
Taxpayers who wish to assign a Reporting Agent (designee) to electronically file and pay on their behalf for the forms listed below must complete
Form IL-8655 and submit it to the designee named. The Reporting Agent must retain this form subject to inspection by the Illinois Department of
Revenue (IDOR) and the Illinois Department of Employment Security (IDES).
Step 1: Taxpayer Information
1
4
___________________________________________________
____________________________________________________
Federal employer identification number (FEIN)
Legal name of business (as shown on tax return)
2
5
___________________________________________________
____________________________________________________
Doing business as (DBA) name (if different than Line 1)
Illinois Account ID
3
6
___________________________________________________
____________________________________________________
Street address
Unemployment Insurance Account number (UI no.)
(
)
-
(
)
-
ext.:
7
___________________________________________________
____________________________________________________
City
State
ZIP
Daytime phone - include area code
FAX number - include area code
Step 2: Reporting Agent Information
7
9
___________________________________________________
___________________________________________________
Federal employer identification number (FEIN)
Reporting Agent name
8
___________________________________________________
Street address
___________________________________________________
City
State
ZIP
Step 3: Check all forms that apply to this authorization
IL-941
IL-501
IL-W-3
UI-3/40
Other ___________________
Step 4: Signature Authorization
Under 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 understand
that this authorization does not absolve me, as the taxpayer, of the responsibility to ensure that all state tax returns are filed and all taxes are
paid on time.
I authorize the Reporting Agent named above (the designee) to sign and file state tax returns transmitted electronically for the tax forms
indicated above. I also authorize the designee to initiate the associated electronic tax payments to IDOR and IDES (for Form UI-3/40). Further,
I authorize the designee to release a copy of this Form IL-8655 to IDOR and IDES (for Form UI-3/40).
I authorize IDOR and IDES (for Form UI-3/40) to disclose confidential tax information to the designee relating to the forms indicated above
that are filed by the designee, and the associated payments that are made by the designee. I certify that I have the authority to authorize
such disclosure on behalf of the taxpayer. This authorization remains in effect until the taxpayer or the designee notifies the other that this
authorization is terminated or revoked.
_____________________________ _____
______________________
__ __/__ __/__ __ __ __
Signature of taxpayer, authorized officer, or partner
Title
Month
Day
Year
*176730001*
This form is authorized as outlined under the Illinois Income Tax Act. Disclosure of
this information is required. Failure to provide information could result in a penalty.
IL-8655 (R-12/17)
Printed by authority of the State of Illinois - Web only
Reset
Print
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
IL-8655
Reporting Agent Electronic Services Authorization
Taxpayers who wish to assign a Reporting Agent (designee) to electronically file and pay on their behalf for the forms listed below must complete
Form IL-8655 and submit it to the designee named. The Reporting Agent must retain this form subject to inspection by the Illinois Department of
Revenue (IDOR) and the Illinois Department of Employment Security (IDES).
Step 1: Taxpayer Information
1
4
___________________________________________________
____________________________________________________
Federal employer identification number (FEIN)
Legal name of business (as shown on tax return)
2
5
___________________________________________________
____________________________________________________
Doing business as (DBA) name (if different than Line 1)
Illinois Account ID
3
6
___________________________________________________
____________________________________________________
Street address
Unemployment Insurance Account number (UI no.)
(
)
-
(
)
-
ext.:
7
___________________________________________________
____________________________________________________
City
State
ZIP
Daytime phone - include area code
FAX number - include area code
Step 2: Reporting Agent Information
7
9
___________________________________________________
___________________________________________________
Federal employer identification number (FEIN)
Reporting Agent name
8
___________________________________________________
Street address
___________________________________________________
City
State
ZIP
Step 3: Check all forms that apply to this authorization
IL-941
IL-501
IL-W-3
UI-3/40
Other ___________________
Step 4: Signature Authorization
Under 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 understand
that this authorization does not absolve me, as the taxpayer, of the responsibility to ensure that all state tax returns are filed and all taxes are
paid on time.
I authorize the Reporting Agent named above (the designee) to sign and file state tax returns transmitted electronically for the tax forms
indicated above. I also authorize the designee to initiate the associated electronic tax payments to IDOR and IDES (for Form UI-3/40). Further,
I authorize the designee to release a copy of this Form IL-8655 to IDOR and IDES (for Form UI-3/40).
I authorize IDOR and IDES (for Form UI-3/40) to disclose confidential tax information to the designee relating to the forms indicated above
that are filed by the designee, and the associated payments that are made by the designee. I certify that I have the authority to authorize
such disclosure on behalf of the taxpayer. This authorization remains in effect until the taxpayer or the designee notifies the other that this
authorization is terminated or revoked.
_____________________________ _____
______________________
__ __/__ __/__ __ __ __
Signature of taxpayer, authorized officer, or partner
Title
Month
Day
Year
*176730001*
This form is authorized as outlined under the Illinois Income Tax Act. Disclosure of
this information is required. Failure to provide information could result in a penalty.
IL-8655 (R-12/17)
Printed by authority of the State of Illinois - Web only
Reset
Print
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