Step 2: Complete the “Signature Declaration”
You must sign a “Signature Declaration” and return it to us if we sent you a notice that you fi led an original return, an
amended return, or any other document that was required to be verifi ed under penalties of perjury, and you did not sign it.
If we requested your signature, you may use the “Signature Declaration” below to provide it. Please sign and date the
“Signature Declaration,” and return it to us at the address listed below.
If you do not provide us with a properly completed and signed “Signature Declaration,” you may be assessed penalties and
interest. For more information on penalties and interest, see Publication 103, Penalties and Interest for Illinois Taxes.
Signature Declaration
Under penalties of perjury, I declare that I did examine the document I fi led and that it, including any accompanying
schedules and statements, was to the best of my knowledge and belief true, correct, and complete. I request that this
document become a permanent part of my return.
Your signature Date Spouse’s signature Date
(required only for a joint Individual Income Tax return)
Illinois Department of Revenue
Clerical Support
PO Box 19084
Springfi eld, IL 62794-9084
IDR-916 (R-6/08)
IL-492-4349
If we requested your signature, please sign the “Signature Declaration” and return this page.
Do not use this form unless we requested a “Signature Declaration” from you.
Illinois Department of Revenue
IDR-916 Signature Declaration
Step 1: Provide the following information
Name as shown on return
Address
City, State, Zip
Daytime telephone number
( )
Identifi cation number (Social Security, federal employer
identifi cation, or Illinois business tax/account ID number)
Account period ending
Tax type (Please check one.)
Individual Income Tax Withholding Income Tax
Business Income Tax Sales Tax
Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
