Are you a business owner in Illinois or someone responsible for filing taxes in the state? If so, then you are likely familiar with Form 45: the Illinois Sales and Other Dispositions of Capital Assets form. This form must be filled out by businesses who have made any capital asset sales during the tax year in order to remain compliant with taxation laws in the state. It is essential to complete this form accurately and on time if applicable, so let's take a closer look at what it entails!
| Question | Answer |
|---|---|
| Form Name | Illinois Form 45 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | illinois form 45 pdf, form 45 illinois, ill form 45, illinois 45 form |
ILLINOIS FORM 45: EMPLOYER'S FIRST REPORT OF INJURY
Please type or print.
Employer's FEIN
Employer's name
Date of report |
Case or File # |
Is this a lost workday case? |
Yes / No
Doing business as
Employer's mailing address
Nature of business or service
SIC code
Name of workers' compensation carrier/admin. |
Policy/Contract # |
Yes / No
Employee's full name |
Social Security # |
Birthdate |
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Employee's mailing address
Employee's
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# Dependents |
Employee's average weekly wage |
Male / Female |
Married / Single |
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Job title or occupation |
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Date hired |
Time employee began work
Date and time of accident
Last day employee worked
If the employee died as a result of the accident, give the date of death. |
Did the accident occur on the employer's premises? |
Yes / No
Address of accident
What was the employee doing when the accident occurred?
How did the accident occur?
What was the injury or illness? List the part of body affected and explain how it was affected.
What object or substance, if any, directly harmed the employee?
Name and address of physician/health care professional
If treatment was given away from the worksite, list the name and address of the place it was given.
Was the employee treated in an emergency room? |
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Was the employee hospitalized overnight as an inpatient? |
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Yes / No |
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Yes |
/ No |
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Report prepared by |
Signature |
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Title and telephone # |
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Please send this form to the ILLINOIS WORKERS' COMPENSATION COMMISSION |
701 S. SECOND STREET SPRINGFIELD, IL 62704. IC45 12/04 |
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By law, employers must keep accurate records of all