State of Illinois
Department of Employment Security
www.ides.illinois.gov
Income Tax Withholding Election
BPP009F Page 1 of 1 TAX-2
Rev. (12/2014)
Claimant Information: SSN:
Last Name: First Name: MI:
Address 1: Address 2: (Apt. / Floor / Suite)
City: State: Zip Code:
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
To change the withholding status on your current claim, please complete the TAX-2 form, then sign and fax or mail the form to:
FAX
MAIL
(630) 495-8199 IDES Claimant Services Center
837 S. Westmore-Meyers Rd.
Lombard, IL 60148
If you elect to have federal and/or State of Illinois income tax deducted and withheld, and later decide you want to make
changes to that election, you will be allowed to do so. The change will be effective for weeks of Unemployment Insurance
Benefits that have not already been paid.
Please read all statements below and choose one of the 2 options for each Tax.
Federal Income Tax Withholding
I voluntarily elect to have federal income tax in the amount of 10% deducted and withheld from my Unemployment
insurance benefit payments.
I do not elect to have any federal income tax deducted and withheld from my unemployment insurance benefit payments.
State of Illinois Income Tax Withholding
I voluntarily elect to have state of Illinois income tax in the amount of 4.95% deducted and withheld from
my unemployment insurance benefit payments.
I do not elect to have any state of Illinois income tax deducted and withheld from my unemployment insurance benefit
payments.
Claimant
Signature: Date:
Office Representative: Date Prepared:
Date Entered:
