Enlarge image | Illinois Department of Revenue 2022 IL-W-6-WS Worksheet to Report Days Worked in Illinois for Non-Residents Read this information first: Complete this worksheet to report any days worked in Illinois, beginning on or after January 1, 2022, and before January 1, 2023. Employees: If you completed 2022 Form IL-W-6, Certificate of Days Worked in Illinois for Non-Residents, you must also complete and submit this worksheet to your employer by January 1, 2023, to report the dates and address of locations worked in Illinois. Attach any additional sheets in the same format as needed. Do not enter the total on your additional sheets.Please keep a copy of this report for your own records. Employers: Enter the business name and FEIN and keep this worksheet with your payroll records. You must send us this information if we request it. Employee name _____________________________________ SSN ____________________________ Business name _____________________________________ FEIN ____________________________ Date worked in Illinois Address of location worked in Illinois include street address and city _________________________________ ________________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ ________________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ ________________________________ _______________________________________ Total Days Worked By signing below, I certify this record of days worked is accurate and complete. ___________________________________ ______________ Employee’s signature Date IL-W-6-WS (R-12/21) This form is authorized under the Illinois Income Tax Act. Disclosure of this information is required. Printed by the authority of the State of Illinois - web only, 1 copy Failure to provide information may result in this form not being processed and may result in a penalty. |