New Submission

PaymentResponsefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
File Date*field type date
Payee Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Payee Address*field type single line
Number, Street, City, State, Zip
Input blocked. Maximum character limit of 4000 characters reached.
Payee Phone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Contact Email*field type email

Local Business Information

(If different than above)

Local Business Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Local Business Addressfield type single line
Number, Street, City, State, Zip
Input blocked. Maximum character limit of 4000 characters reached.
Local Business Phonefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Local Business Emailfield type email

	Collection Month*field type drop-down	Year*field type drop-down
row 1	Collection Month*field type drop-down	Year*field type drop-down

IBT Number for this locationfield type single line
from Illinois DOR ST-1
Input blocked. Maximum character limit of 4000 characters reached.
Gross Monthly Rental or Lease Amount*field type number
City Tax Ratefield type currency
$
Taxfield type currency
$
Administrative Collection Creditfield type currency
$
Late Return?*field type radio button
Late Return?NoYes

Payment Option*field type radio button
Payment OptionACH PaymentCheckPay Online with Credit Card
City Treasurer Carolyn Lynch will email you the ACH information needed for the transaction.
Please mail your check to:
City of McHenry
c/o Carolyn Lynch
333 S Green St
McHenry, IL 60050
Under penalties of perjury and other penalties provided by law, I declare that I have examined this return and to the best of my knowledge and belief it is true, correct, and complete. I further declare that the information set forth is taken from the books and records of the business for which the return is filed.
Checkbox*field type checkbox
CheckboxI understand that checking this box constitutes a legal signature and confirms that I have filled out this form to the best of my ability.
Signature*field type signature

Payment Amount*field type currency
$
Name on Credit Card*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
CVV*(?)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Billing Zip Code*(?)field type single line
Input blocked. Maximum character limit of 4000 characters reached.

Tokenfield type single line
Input blocked. Maximum character limit of 4000 characters reached.