Illinois Department of Revenue Individual Income Tax Return IL-1040 Front (R-12/21) Printed by authority of the State of Illinois - web only, 1. 2021 Form IL-1040 Step 2: Income 1 Federal adjusted gross income from your federal Form 1040 or 1040-SR, Line 11. 1 .00 2 Federally tax-exempt interest and dividend income from your federal Form 1040 or 1040-SR, Line 2a. 2 .00 3 Other additions. Attach Schedule M. 3 .00 4 Total income. Add Lines 1 through 3. 4 .00 Step 3: Base Income 5 Social Security benefits and certain retirement plan income received if included in Line 1. Attach Page 1 of federal return. 5 .00

6 Illinois Income Tax overpayment included in federal Form 1040 or 1040-SR,

Schedule 1, Ln. 1. 6 .00

7 Other subtractions. Attach Schedule M. 7 .00 Check if Line 7 includes any amount from Schedule 1299-C.

8 Add Lines 5, 6, and 7. This is the total of your subtractions. 8 .00

9 Illinois base income. Subtract Line 8 from Line 4. 9 .00

Step 4: Exemptions

10 a Enter the exemption amount for yourself and your spouse. See instructions. a .00

b Check if 65 or older: You + Spouse # of checkboxes x $1,000 = b .00

c Check if legally blind: You + Spouse # of checkboxes x $1,000 = c .00 d If you are claiming dependents, enter the amount from Schedule IL-E/EIC, Step 2, Line 1.

Attach Schedule IL-E/EIC. d .00 Exemption allowance. Add Lines 10a through 10d. 10 .00 Step 5: Net Income and Tax 11 Residents: Net income. Subtract Line 10 from Line 9. Nonresidents and part-year residents: Enter the Illinois net income from Schedule NR. Attach Schedule NR. 11 .00 12 Residents: Multiply Line 11 by 4.95% (.0495). Cannot be less than zero. Nonresidents and part-year residents: Enter the tax from Schedule NR. 12 .00

13 Recapture of investment tax credits. Attach Schedule 4255.

` 13 .00

14 Income tax. Add Lines 12 and 13. Cannot be less than zero. 14 .00

Step 6: Tax After Nonrefundable Credits

15 Income tax paid to another state while an Illinois resident. Attach Schedule CR. 15 .00

16 Property tax and K-12 education expense credit amount from Schedule ICR. Attach Schedule ICR. 16 .00

17 Credit amount from Schedule 1299-C. Attach Schedule 1299-C. 17 .00

18 Add Lines 15, 16, and 17. This is the total of your credits. Cannot exceed the tax amount on Line 14. 18 .00

19 Tax after nonrefundable credits. Subtract Line 18 from Line 14. 19 .00

Step 7: Other Taxes

20 Household employment tax. See instructions. 20 .00

21 Use tax on internet, mail order, or other out-of-state purchases from UT Worksheet or UT Table in the instructions. Do not leave blank. 21 .00 22 Compassionate Use of Medical Cannabis Program Act and sale of assets by gaming licensee surcharges. 22 .00

23 Total Tax. Add Lines 19, 20, 21, and 22. 23 .00 or for fiscal year ending / Staple your check and IL-1040-V Staple W-2 and 1099 forms here (Whole dollars only)

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. *60012211W* Step 1: Personal Information Over 80% of taxpayers file electronically. It is easy and you will get your refund faster. Visit tax.illinois.gov. Mailing address (See inst. if foreign address) Apartment number Spouse’s first name and middle intial City State Spouse’s last name Spouse’s year of birth Your last name Your social security number Year of birth Foreign nation if not US (do not abbreviate) Email address Zip or postal code County (Illinois only) B Filing status: Single Married filing jointly Married filing separately Widowed Head of household C Check If someone can claim you, or your spouse if filing jointly, as a dependent. See instructions. You Spouse D Check the box if this applies to you during 2021: Nonresident - Attach Sch. NR Part-year resident - Attach Sch. NR Enter personal information and Social Security numbers (SSN). You must provide the entire SSN(s) - no partial SSN. A Your first name and middle initial Spouse’s social security number Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.

24 Total tax from Page 1, Line 23. 24 .00 Step 8: Payments and Refundable Credit 25 Illinois Income Tax withheld. Attach Schedule IL-WIT. 25 .00 26 Estimated payments from Forms IL-1040-ES and IL-505-I, including any overpayment applied from a prior year return. 26 .00 27 Pass-through withholding. Attach Schedule K-1-P or K-1-T. 27 .00 28 Pass-through entity tax credit. Attach Schedule K-1-P or K-1-T. 28 .00 29 Earned Income Credit from Schedule IL-E/EIC, Step 4, Line 8. Attach Schedule IL-E/EIC. 29 .00 30 Total payments and refundable credit. Add Lines 25 through 29.

30 .00 Step 9: Total 31 If Line 30 is greater than Line 24, subtract Line 24 from Line 30. 31 .00 32 If Line 24 is greater than Line 30, subtract Line 30 from Line 24. 32 .00 Step 10: Underpayment of Estimated Tax Penalty and Donations - Only complete Step 10 for late-payment penalty for underpayment of estimated tax or to make a voluntary charitable donation. 33 Late-payment penalty for underpayment of estimated tax.

33 .00 a Check if at least two-thirds of your federal gross income is from farming. b Check if you or your spouse are 65 or older and permanently living in a nursing home.

c Check if your income was not received evenly during the year and you annualized your income on Form IL-2210. Attach Form IL-2210. d Check if you were not required to file an Illinois Individual Income Tax return in the previous tax year.

34 Voluntary charitable donations. Attach Schedule G. 34 .00 35 Total penalty and donations. Add Lines 33 and 34. 35 .00 Step 11: Refund 36 If you have an amount on Line 31 and this amount is greater than Line 35, subtract Line 35 from Line 31. This is your overpayment. 36 .00 37 Amount from Line 36 you want refunded to you. Check one box on Line 38. See instructions.

37 .00 38 I choose to receive my refund by a direct deposit - Complete the information below if you check this box.

Routing number Checking or Savings

Account number

b paper check. 39 Amount to be credited forward. Subtract Line 37 from Line 36. See instructions. 39 .00 Step 12: Amount You Owe 40 If you have an amount on Line 32, add Lines 32 and 35. - or - If you have an amount on Line 31 and this amount is less than Line 35, subtract Line 31 from Line 35. This is the amount you owe. See instructions. 40 .00 Step 13: If this is a joint return, both you and your spouse must sign below. Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete. IL-1040 Back (R-12/21) Refer to the 2021 IL-1040 Instructions for the address to mail your return. . DR AP RR DC IR ID Check if the Department may discuss this return with the third party designee shown in this step. Paid Preparer Use Only Firm’s name Firm’s FEIN Print/Type paid preparer’s name Firm’s address Firm’s phone Paid preparer’s signature Date (mm/dd/yyyy) Paid Preparer’s PTIN ( ) Check if self-employed Sign Here Your signature Date (mm/dd/yyyy) Spouse’s signature Daytime phone number ( ) Date (mm/dd/yyyy) Third Party Designee Designee’s name (please print) Designee’s phone number ( ) *60012212W* You may also contribute to college savings funds here. See instructions! Reset Print