Form St-17 - Annual Report Of Manufacturer'S Purchase Credit Used
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Illinois Department of Revenue
ST-17
Annual Report of Manufacturer’s
03
064 Station 266
REV
Form
Purchase Credit Used
E S _____/_____/_____
NS
CA
Step 1:
Identify your business
1
4
Business name
_____________________________________
Illinois account ID number __ __ __ __ - __ __ __ __
If you do not have an account ID number, check this box
and
write your federal employer identification number (FEIN).
2
Business address _____________________________________
__ __ - __ __ __ __ __ __ __
Street address
5
__________________________________________________
Write the purchase year: January through December
__ __ __ __
__
City
State
ZIP
This report is due by June 30 of the following year.
Year
3
Business phone number (______)________________________
Step 2: Identify the production-related purchases for which MPC was used
(Do not round your figures.)
A
B
C
D
Month of
Taxable purchase price
Taxable purchase price
Total taxable
Amount of
production-related
of items purchased
of items purchased
purchase price
credit used
purchase
in Illinois
out-of-state
(Must not exceed 6.25%
of Column C)
1
January
$ _____________________ $ _____________________ $ _____________________ $ ___________________
2
February
$ _____________________ $ _____________________ $ _____________________ $ ___________________
3
March
$ _____________________ $ _____________________ $ _____________________ $ ___________________
4
April
$ _____________________ $ _____________________ $ _____________________ $ ___________________
5
May
$ _____________________ $ _____________________ $ _____________________ $ ___________________
6
June
$ _____________________ $ _____________________ $ _____________________ $ ___________________
7
July
$ _____________________ $ _____________________ $ _____________________ $ ___________________
8
August
$ _____________________ $ _____________________ $ _____________________ $ ___________________
9
September
$ _____________________ $ _____________________ $ _____________________ $ ___________________
10
October
$ _____________________ $ _____________________ $ _____________________ $ ___________________
11
November
$ _____________________ $ _____________________ $ _____________________ $ ___________________
12
December
$ _____________________ $ _____________________ $ _____________________ $ ___________________
Totals $
$
_____________________
___________________
(Column C)
(Column D)
Step 3: Sign below
Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete.
__ __ /__ __ / __ __ __ __
______________________________________________________________(____)________________
Taxpayer’s signature
Daytime phone number
Date
__ __ /__ __ / __ __ __ __
______________________________________________________________(____)________________
Preparer’s signature
Preparer’s name (Please print.)
Daytime phone number
Date
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
ST-17 (R-09/14)
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