Application Examples: Illinois Journalism Payroll Tax Credit
Use the blank application and two completed examples to guide your newsroom through the Local Journalism Sustainability Tax Incentive Program’s application process
FAQ | Application Guidance | Application Examples
Required Uploads
Before starting, applicant must have ready:
- Beneficial Ownership Form (official template)
- Qualified Journalist Form (official template)
- Cash Flow Statement (prior taxable year – showing gross receipts)
- Income Statement (prior taxable year – showing revenue earned)
May also be requested:
- IRS Form 990 (if nonprofit)
- USPS Periodical Permit
- Images of local news stories
- Analytics report reflecting digital coverage
- Publicly posted beneficial ownership or board disclosure
SECTION 1: APPLICATION INFORMATION
1.1 Type of Application *
☐ Initial Application
☐ Appeal
SECTION 2: APPLICANT INFORMATION
2.1 Local News Organization Name *
Legal name; must match registration or tax documents
2.2 Type of Local News Organization *
☐ Print Only
☐ Digital Only
☐ Hybrid (Print and Digital)
☐ Other: _______________________
2.3 FEIN * _______________
2.4 Website URL _______________
2.5 Address of the Local News Organization *
- Street Address
- Street Address Line 2
- City
- State / Province
- Postal / ZIP Code
2.6 County of the Local News Organization *
County of the organization’s address
2.7 Organizational Status *
☐ For-profit entity
☐ Not-for-profit entity
2.8 Is the Local News Organization a publicly traded entity? *
☐ Yes
☐ No
2.9 Is the Local News Organization a subsidiary? *
☐ Yes
☐ No
SECTION 3: FINANCIAL & ELIGIBILITY INFORMATION
3.1 Journalism Activity Certification *
Does the Local News Organization engage professionals to create, edit, produce, AND distribute original content concerning matters of public interest through reporting activities (interviews, observation, document analysis, etc.)?
☐ Yes
☐ No
3.2 Qualified Journalist Presence *
Does the organization have at least one employee who meets ALL of the following:
- Employed full-time (≥30 hours/week)
- Primarily covers Illinois or local Illinois community news
- Gathers, prepares, photographs, writes, edits, reports, or publishes original local or state news
- Lives within 50 miles of the coverage area
☐ Yes
☐ No
3.3 Illinois Withholding Requirement *
Is the organization required to deduct and withhold taxes under Article 7 of the Illinois Income Tax Act?
☐ Yes
☐ No
3.4 Tax Year Alignment *
Does the organization’s taxable year run concurrently with the calendar year?
☐ Yes
☐ No
SECTION 4: GROSS RECEIPTS (PRIOR TAXABLE YEAR)
4.1 Total Gross Receipts *
Dollar amount
4.2 Payments from Political or Advocacy Entities *
Of total gross receipts, amount received from:
- PACs
- Section 527 entities
- 501(c)(4) or 501(c)(6) organizations
Dollar amount
4.3 Political Advertising (Lowest Unit Rate) *
Of the above, amount attributable to political advertising during lowest unit windows
Dollar amount
4.4 Upload: Cash Flow Statement *
Must reflect values above
4.5 Political Funding Threshold *
Has the organization received more than $100,000 from political/advocacy entities in the current or any preceding taxable year?
☐ Yes
☐ No
SECTION 5: REVENUE (PRIOR TAXABLE YEAR)
5.1 Total Revenue Earned *
Dollar amount_______________
5.2 Political Advertising Revenue *
Of total revenue, amount earned from political ads during lowest unit windows
Dollar amount
5.3 Upload: Income Statement *
Must reflect values above
SECTION 6: BENEFICIAL OWNERSHIP / GOVERNANCE
6.1 Percentage Owned by Publicly Traded Entities *
Enter percentage (e.g., 24.58)
6.2 Private Fund Ownership *
Does the organization list a private fund among its beneficial ownership?
☐ Yes
☐ No
6.3 Upload: Beneficial Ownership Form *
Must use official template
SECTION 7: QUALIFIED JOURNALISTS
7.1 Qualified Journalists – January 1 (Prior Year) *
Value from Qualified Journalist Form §2(a)
7.2 Qualified Journalists – January 1 (Current Year) *
Value from Qualified Journalist Form §2(b)
7.3 Qualified Journalists – Trailing 12 Months *
Value from Qualified Journalist Form §2(c)
7.4 New Journalism Positions Filled (Trailing 12 Months) *
Value from Qualified Journalist Form §2(d)
7.5 Upload: Qualified Journalist Form *
Must use official template
SECTION 8: CONTACT INFORMATION
8.1 Primary Contact Name *
8.2 Title *
8.3 Email Address *
8.4 Phone Number *
SECTION 9: CERTIFICATION
9.1 Authorized Executive Officer / Individual
- Name *
- Title *
- Date *
- Signature *
Certification Statement (acknowledged by signer):
I certify that I have read and understood the requirements of this application; that the information provided is true, complete, and accurate; and that all persons with an interest in the business or assets of the applicant have been disclosed. I understand false statements may result in penalties.
SECTION 10: PRIVACY NOTICE (ACKNOWLEDGMENT)
SSNs or personal identifiers may be requested as required by law. Failure to provide required information may prevent participation in the program.
Example #1– County Herald
(Small Local Print Newspaper – For-Profit)
SECTION 0: REQUIRED UPLOADS (CONFIRMED)
☑ Beneficial Ownership Form
☑ Qualified Journalist Form
☑ Cash Flow Statement (prior taxable year)
☑ Income Statement (prior taxable year)
SECTION 1: APPLICATION INFORMATION
Type of Application*
☑ Initial Application
☐ Appeal
SECTION 2: APPLICANT INFORMATION
Local News Organization Name*
County Herald
Type of Local News Organization*
☑ Print Only
☐ Digital Only
☐ Hybrid
☐ Other
FEIN*
12-3456789
Website URL
https://www.countyheraldnews.com
Address of the Local News Organization*
123 Main Street
Suite 1
Quincy, IL
62301
County of the Local News Organization*
Adams County
The Local News Organization is a*
☑ For-profit entity
☐ Not-for-profit entity
Is the Local News Organization publicly traded?*
☐ Yes
☑ No
Is the Local News Organization a subsidiary?*
☐ Yes
☑ No
SECTION 3: FINANCIAL & ELIGIBILITY INFORMATION
Engages in original journalism covering matters of public interest?*
☑ Yes
☐ No
Has at least one qualified journalist meeting all statutory criteria?*
☑ Yes
☐ No
Required to deduct and withhold Illinois income taxes?*
☑ Yes
☐ No
Taxable year runs concurrently with calendar year?*
☑ Yes
☐ No
SECTION 4: GROSS RECEIPTS (PRIOR TAXABLE YEAR)
Total gross receipts*
$230,000
Payments from PACs / 527s / 501(c)(4)/(6) entities*
$15,000
Political advertising during lowest unit windows*
$8,000
Cash Flow Statement uploaded*
☑ Yes
Received more than $100,000 from political/advocacy entities (current or prior year)?*
☐ Yes
☑ No
SECTION 5: REVENUE (PRIOR TAXABLE YEAR)
Total revenue earned*
$210,000
Revenue from political advertising during lowest unit windows*
$8,000
Income Statement uploaded*
☑ Yes
SECTION 6: BENEFICIAL OWNERSHIP / GOVERNANCE
Percentage owned by publicly traded entities*
0.00%
Private fund listed among beneficial ownership?*
☐ Yes
☑ No
Beneficial Ownership Form uploaded*
☑ Yes
SECTION 7: QUALIFIED JOURNALISTS
Qualified journalists on Jan 1 (preceding year)*
3
Qualified journalists on Jan 1 (current year)*
3
Qualified journalists employed in prior 12 months*
3
New journalism positions filled in prior 12 months*
0
Qualified Journalist Form uploaded*
☑ Yes
SECTION 8: CONTACT INFORMATION
Name*
Person A
Title*
Editor-in-Chief
Email*
personA@countyheraldnews.com
Phone*
(217) 000-0000
SECTION 9: CERTIFICATION
Authorized Executive Officer Name*
Person A
Title*
Editor-in-Chief
Date*
January 15, 2026
Signature*
/s/ Person A
View the completed Beneficial Ownership and Qualified Journalists Forms.
Example #2– Neighborhood Newsroom
(Digital-Only Nonprofit – 501(c)(3))
SECTION 0: REQUIRED UPLOADS (CONFIRMED)
☑ Beneficial Ownership / Board Governance Form
☑ Qualified Journalist Form
☑ Cash Flow Statement (prior taxable year)
☑ Income Statement (prior taxable year)
☑ IRS Form 990
SECTION 1: APPLICATION INFORMATION
Type of Application*
☑ Initial Application
☐ Appeal
SECTION 2: APPLICANT INFORMATION
Local News Organization Name*
Neighborhood Newsroom
Type of Local News Organization*
☐ Print Only
☑ Digital Only
☐ Hybrid
☐ Other
FEIN*
98-7654321
Website URL
https://www.neighborhoodnewsroom.org
Address of the Local News Organization*
456 Community Way
Floor 2
Chicago, IL
60621
County of the Local News Organization*
Cook County
The Local News Organization is a*
☐ For-profit entity
☑ Not-for-profit entity
Is the Local News Organization publicly traded?*
☐ Yes
☑ No
Is the Local News Organization a subsidiary?*
☐ Yes
☑ No
SECTION 3: FINANCIAL & ELIGIBILITY INFORMATION
Engages in original journalism covering matters of public interest?*
☑ Yes
☐ No
Has at least one qualified journalist meeting all statutory criteria?*
☑ Yes
☐ No
Required to deduct and withhold Illinois income taxes?*
☑ Yes
☐ No
Taxable year runs concurrently with calendar year?*
☑ Yes
☐ No
SECTION 4: GROSS RECEIPTS (PRIOR TAXABLE YEAR)
Total gross receipts*
$450,000
Payments from PACs / 527s / 501(c)(4)/(6) entities*
$0
Political advertising during lowest unit windows*
$0
Cash Flow Statement uploaded*
☑ Yes
Received more than $100,000 from political/advocacy entities (current or prior year)?*
☐ Yes
☑ No
SECTION 5: REVENUE (PRIOR TAXABLE YEAR)
Total revenue earned*
$400,000
Revenue from political advertising during lowest unit windows*
$0
Income Statement uploaded*
☑ Yes
SECTION 6: BENEFICIAL OWNERSHIP / GOVERNANCE
Percentage owned by publicly traded entities*
0.00%
Private fund listed among beneficial ownership?*
☐ Yes
☑ No
Beneficial Ownership / Board Governance Form uploaded*
☑ Yes
SECTION 7: QUALIFIED JOURNALISTS
Qualified journalists on Jan 1 (preceding year)*
3
Qualified journalists on Jan 1 (current year)*
4
Qualified journalists employed in prior 12 months*
4
New journalism positions filled in prior 12 months*
2
Qualified Journalist Form uploaded*
☑ Yes
SECTION 8: CONTACT INFORMATION
Name*
Person A
Title*
Managing Editor
Email*
personA@neighorhoodnewsroom.org
Phone*
(312) 000-000
SECTION 9: CERTIFICATION
Authorized Executive Officer Name*
Person A
Title*
Managing Editor
Date*
January 15, 2026
Signature*
/s/ Person A
View the completed Beneficial Ownership and Qualified Journalists Forms.
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