Agritourism Liability Insurance Tax Credit Application

Title

Name of person or business

Enter the name to be used when claiming credit on income tax form

Tax Identification Number

Enter the Tax ID Number OR Last 4 of SSN to be used when claiming credit on income tax form

Which income tax form will the credit be claimed

Individual Income Tax Return – IL-1040

Corporation Income and Replacement Tax - IL-1120

Exempt Organization Income and Replacement Tax - IL-990-T

Fiduciary Income and Replacement Tax - IL-1041

Partnership Replacement Tax - IL-1065

Small Business Corporation Replacement Tax - IL-1120-ST

Identify which income tax form you’ll use to claim the credit

Contact person or business

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Mailing: Street Address

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Mailing: City

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Mailing: State

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Mailing: Zipcode

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Business Site: Address

Business Site: City

Business Site: State

Business Site: Zipcode

Email Address

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Phone number

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Tax Year

January 1, 2022 - December 21, 2022

January 1, 2023 - December 21, 2023

Each tax year requires its own application

Liability Insurance Paid

Amount Paid for the tax year selected above or $1,000 whichever is less

Verification of Agritourism Operation

historic, cultural, and on-site educational programs;

guided and self-guided tours, including school tours;

animal exhibitions or petting zoos;

agricultural crop mazes, such as corn or flower mazes;

harvest-your-own or U-pick operations;

horseback or pony rides; or

hayrides or sleigh rides

other:

I verify that during the tax year which I am applying, I have conducted business as an Agritourism operation that provided: (Check all that apply)

If Other Agritourism Operation

Verification

Under penalties of perjury, I verify that, per the definitions above, my operation meets the criteria to be an agritourism operation. This application, to the best of my knowledge, it is true, correct and complete.

Please fill out this field.

Liability Insurance

I have attached a copy of my liability insurance policy below

Attach a copy of liability insurance for the tax year selected above

Liability Insurance Payment

I have attached a copy of the receipt showing payment for my liability insurance policy

Attach the receipt for the applicable liability insurance policy

Attachments

Multiple files can be uploaded by holding down Shift or Ctrl while selecting.