Form ETS-33 Application for Duplicate Credit Memorandum - Illinois

Form ETS-33 or the "Application For Duplicate Credit Memorandum" is a form issued by the Illinois Department of Revenue.

Download a PDF version of the Form ETS-33 down below or find it on the Illinois Department of Revenue Forms website.

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Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue
ETS-33
Application for
Duplicate Credit Memorandum
Step 1: Identify your business
License number _______________________
Account ID _______________________
Name
_________________________________________________________________________________________
Address
_________________________________________________________________________________________
City, State, ZIP _________________________________________________________________________________________
Step 2: Identify the requestor
Name of person or firm making this request __________________________________________________________________
Please print
Title (if corporation) _____________________________________________________________________________________
Step 3: Credit memorandum to be transferred
(to be completed by Department personnel)
Original credit memo:
Reissued credit memo:
Letter ID
_______________________
Letter ID
_______________________
Date on original credit memo
__ __ / __ __ / __ __ __ __
Date on reissued credit memo
__ __ / __ __ / __ __ __ __
Month
Day
Year
Month
Day
Year
Original credit memo amount
$_______________________
Reissued credit memo amount $_______________________
Step 4: Sign below
I state that the original credit memorandum shown above and issued by the Illinois Department of Revenue has been
misplaced, lost, or destroyed, thereby preventing the use of all or part of the amount either to pay any current or future taxes
due the Department or to transfer to another account.
Signature ________________________________________________________________
Date______________________
Step 5: Mail the form
Mail this completed form to:
ALCOHOL TOBACCO AND FUEL DIVISION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
For questions, visit our website at tax.illinois.gov or call us weekdays between 8 a.m. and 4:30 p.m. at 217 782-6045.
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
ETS-33 (R-02/16)
Reset
Print
Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Illinois Department of Revenue
ETS-33
Application for
Duplicate Credit Memorandum
Step 1: Identify your business
License number _______________________
Account ID _______________________
Name
_________________________________________________________________________________________
Address
_________________________________________________________________________________________
City, State, ZIP _________________________________________________________________________________________
Step 2: Identify the requestor
Name of person or firm making this request __________________________________________________________________
Please print
Title (if corporation) _____________________________________________________________________________________
Step 3: Credit memorandum to be transferred
(to be completed by Department personnel)
Original credit memo:
Reissued credit memo:
Letter ID
_______________________
Letter ID
_______________________
Date on original credit memo
__ __ / __ __ / __ __ __ __
Date on reissued credit memo
__ __ / __ __ / __ __ __ __
Month
Day
Year
Month
Day
Year
Original credit memo amount
$_______________________
Reissued credit memo amount $_______________________
Step 4: Sign below
I state that the original credit memorandum shown above and issued by the Illinois Department of Revenue has been
misplaced, lost, or destroyed, thereby preventing the use of all or part of the amount either to pay any current or future taxes
due the Department or to transfer to another account.
Signature ________________________________________________________________
Date______________________
Step 5: Mail the form
Mail this completed form to:
ALCOHOL TOBACCO AND FUEL DIVISION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
For questions, visit our website at tax.illinois.gov or call us weekdays between 8 a.m. and 4:30 p.m. at 217 782-6045.
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
ETS-33 (R-02/16)
Reset
Print
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