OFFICE OF THE ILLINOIS STATE TREASURER
ESTATE TAX PAYMENT FORM
Send this completed form, along with your payment, to the following address:
Illinois State Treasurer's Office
Attn: Estate Tax Section
400 W. Monroe St., 4th Fl.
Springfield, IL 62704
Checks must be made payable to: ILLINOIS STATE TREASURER
We accept Check, Money Order, Cashier's Check and ACH. WE DO NOT ACCEPT CASH.
Payments may also be made in person at the following locations:
Illinois State Treasurer's Office Illinois State Treasurer's Office
400 W. Monroe St., 4th Fl. 100 W. Randolph St., Suite 15-600
Springfield, IL 62704 Chicago, IL 60601
For ACH instructions, or any other questions, please call our Toll Free Number: 1-800-252-8919
To be completed by Estate Representative:
DECEDENT NAME: ____________________________
DATE OF DEATH: _____________________________
DECEDENT SSN: __________________________ COUNTY OF ASSESSMENT: ____________________
AMOUNT OF PAYMENT: $ ______________________
NAME AND ADDRESS OF PERSON TO RECEIVE PAYMENT RECEIPT:
NAME, PHONE NUMBER AND E-MAIL ADDRESS OF CONTACT PERSON FOR ESTATE:
To be completed by staff for walk-ins:
Date Stamp:
To be completed by Springfield Estate Tax staff:
Mailed/Credit Date:
Payment Received: $
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Date Stamp:
Received By: ________________________
