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Instructions: |
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1) Enter the employer
information. |
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2)
Enclose a check equal to the total amount withheld for all the employees
paying child support |
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3) Complete and Print the
list form |
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4) Make check payable to:
Illinois State Disbursement Unit |
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5) Mail the check and the
list form to: |
Illinois State
Disbursement Unit |
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P.O. Box 5400 |
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Carol Stream, IL
60197-5400 |
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Counties |
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001 ADAMS |
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003 ALEXANDER |
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005 BOND |
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007 BOONE |
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009 BROWN |
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011 BUREAU |
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013 CALHOUN |
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015 CARROLL |
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EMPLOYER
INFORMATION[1] |
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017 CASS |
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Employer Name |
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019 CHAMPAIGN |
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Contact Name |
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021 CHRISTIAN |
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Address |
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023 CLARK |
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025 CLAY |
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City |
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State - Zip |
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027 CLINTON |
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Telephone Number |
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Fax Number |
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029 COLES |
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031 COOK |
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033 CRAWFORD |
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Employee Name[2] |
SSN[3] |
County[4] |
Docket Number[5] |
Dollar Amount[6] |
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035 CUMBERLAND |
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037 DE KALB |
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039 DE WITT |
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041 DOUGLAS |
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043 DU PAGE |
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045 EDGAR |
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047 EDWARDS |
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049 EFFINGHAM |
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051 FAYETTE |
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053 FORD |
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055 FRANKLIN |
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057 FULTON |
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059 GALLATIN |
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061 GREENE |
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063 GRUNDY |
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065 HAMILTON |
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067 HANCOCK |
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069 HARDIN |
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071 HENDERSON |
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073 HENRY |
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075 IROQUOIS |
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077 JACKSON |
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079 JASPER |
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081 JEFFERSON |
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083 JERSEY |
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085 JO DAVIESS |
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087 JOHNSON |
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089 KANE |
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091 KANKAKEE |
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093 KENDALL |
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095 KNOX |
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097 LAKE |
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099 LA SALLE |
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101 LAWRENCE |
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TOTAL AMOUNT |
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$ - |
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103 LEE |
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105 LIVINGSTON |
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107 LOGAN |
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109 MCDONOUGH |
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111 MCHENRY |
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113 MCLEAN |
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115 MACON |
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117 MACOUPIN |
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119 MADISON |
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121 MARION |
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123 MARSHALL |
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125 MASON |
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127 MASSAC |
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129 MENARD |
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131 MERCER |
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133 MONROE |
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135 MONTGOMERY |
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137 MORGAN |
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139 MOULTRIE |
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141 OGLE |
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143 PEORIA |
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145 PERRY |
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147 PIATT |
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149 PIKE |
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151 POPE |
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153 PULASKI |
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155 PUTNAM |
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157 RANDOLPH |
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159 RICHLAND |
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161 ROCK ISLAND |
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163 ST CLAIR |
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165 SALINE |
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167 SANGAMON |
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169 SCHUYLER |
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171 SCOTT |
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173 SHELBY |
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175 STARK |
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177 STEPHENSON |
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179 TAZEWELL |
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181 UNION |
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183 VERMILION |
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185 WABASH |
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187 WARREN |
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189 WASHINGTON |
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191 WAYNE |
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193 WHITE |
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195 WHITESIDE |
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197 WILL |
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199 WILLIAMSON |
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201 WINNEBAGO |
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203 WOODFORD |
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