ILLINOIS DEPARTMENT OF REVENUE 

                    DRAFT FORM 

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IDR-1-DIS (N-08/23)          Printed by authority of State of Illinois, web only – one copy. 
 

                                                                                   *33912191V*
       Illinois Department of Revenue                                                                                                       Year ending
                                                                                                                                            
                                                                                                                                           Month  Year
       ScheduleAttach to your Form IL-1120, IL-1120-ST,NB orNonbusinessIL-1065.    Income                                                   IL Attachment No. 17

Enter your name as shown on your Form IL-1120, IL-1120-ST, or IL-1065.             Enter your federal employer identification number (FEIN). 

                                   Read the instructions before completing this form.

                                                                                   Column A                                                Column B
       TENTATIVE FINAL
                                                                                   Total everywhere                                        Allocable to Illinois

  1  Interest*                                                             1                                                              

  2  Dividends*                                                           2                                                               

    3Rental income                                                        3                                                               

  4  Patent royalties                                                       4                                                             

    5Copyright royalties                                                  5                                                               

    6Other royalty income                                                 6                                                               

    7Capital gain (loss) from real property                                 7                                                             

    8Capital gain (loss) from tangible personal property                    8                                                             

    9Capital gain (loss) from intangible personal property                  9                                                             

10  Other (specify)                                                     10                                                                

11  Recaptured business expense (see instructions).
               You must complete the apportionment factor 
      worksheet below to get the correct figure for Column B.           11                                                                

12    Totals. Add Lines 1 through 11 for each column.                   12                                                                
  Apportionment factor worksheet (see instructions) 
   a  Enter your apportionment factor from two years ago (if applicable).  a
     bEnter your apportionment factor from last year’s tax return.         b 
     cEnter your apportionment factor from this year’s tax return.         c 
   d  Add Lines a, b, and c.                                               d 
   e  If you have an amount on Line a, divide Line d by 3.
      If you do not have an amount on Line a, divide Line d by 2.          e 
   f  Enter the greater of Line c or Line e. 
      This is your apportionment factor.                                     f
   g  Multiply Column A, Line 11 by Line f, and enter the result 
      here and in Column B, Line 11.                                        g  

* Interest and dividends are allocable to Illinois if your commercial domicile  was in Illinois at the time the interest or dividend was paid or accrued.

                                             This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this Printed by the authority of the state 
       Schedule NB (R-12/19)                 information is REQUIRED. Failure to provide information could result in a penalty.     of Illinois - electronic only - one copy.