Get Il 5754 Form

Illinois Department of Revenue IL-5754 Statement by Person Receiving Gambling Winnings Who must complete this form gambling winnings over 1 000. Signature Date Note Give your completed and signed form to the person who pays you the winnings. IL-5754 R-12/05 This form is authorized under the Illinois Income Tax Act. Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes. This form provides a record of who received winnings and to whom the winnings are taxable. The payer will use this information to prepare Form W 2G* What if I need additional assistance Step 2 Who will receive winnings Complete the following information for each person receiving winnings. 1 Taxpayer identification number SSN or FEIN Amount won If you need assistance visit our website at tax. illinois. gov call our Taxpayer Assistance Division at 1 800 732 8866 or 217 782-3336 or call our TDD telecommunications device for the deaf at 1 800 544-5304. Our office hours are 8 a*m* to 5 p*m* Step 1 Winnings information Complete the following information* Street address Date of payment // Type of winnings Total won Illinois Income Tax withheld Write the Social Security number SSN or federal employer identification number FEIN name and address of the person to whom winnings were made payable. Name City State ZIP Under penalties of perjury I declare that to the best of my knowledge and belief the names addresses and taxpayer identifying numbers which I have furnished correctly identify me as the recipient of this payment and correctly identify each person entitled to any portion of this payment. Disclosure of this information is required* Failure to provide information may result in this form not being processed and may result in a penalty. This form provides a record of who received winnings and to whom the winnings are taxable. The payer will use this information to prepare Form W 2G* What if I need additional assistance Step 2 Who will receive winnings Complete the following information for each person receiving winnings. 1 Taxpayer identification number SSN or FEIN Amount won If you need assistance visit our website at tax. 1 Taxpayer identification number SSN or FEIN Amount won If you need assistance visit our website at tax. illinois. gov call our Taxpayer Assistance Division at 1 800 732 8866 or 217 782-3336 or call our TDD telecommunications device for the deaf at 1 800 544-5304. illinois. gov call our Taxpayer Assistance Division at 1 800 732 8866 or 217 782-3336 or call our TDD telecommunications device for the deaf at 1 800 544-5304. Our office hours are 8 a*m* to 5 p*m* Step 1 Winnings information Complete the following information* Street address Date of payment // Type of winnings Total won Illinois Income Tax withheld Write the Social Security number SSN or federal employer identification number FEIN name and address of the person to whom winnings were made payable. Our office hours are 8 a*m* to 5 p*m* Step 1 Winnings information Complete the following information* Street address Date of payment // Type of winnings Total won Illinois Income Tax withheld Write the Social Security number SSN or federal employer identification number FEIN name and address of the person to whom winnings were made payable. Name City State ZIP Under penalties of perjury I declare that to the best of my knowledge and belief the names addresses and taxpayer identifying numbers which I have furnished correctly identify me as the recipient of this payment and correctly identify each person entitled to any portion of this payment.