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INTERNET ACCESS REQUEST FORM Please provide the following information about yourself Daytime phone Name - Address City State Social Security number E-mail address Drivers license number Signature Date Mail your request to Phone Fax E-mail ZIP ILLINOIS DEPARTMENT OF REVENUE ATTN BRENDA CAWLEY 101 WEST JEFFERSON STREET MC 4-500 PO BOX 19033 SPRINGFIELD IL 62794-9033 217 785-6636 217 782-9932 Brenda*Cawley illinois. gov Assessing officials with Internet access can now view their personal education ...

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