Form Rc-6-A-X - Amended Out-Of-State Cigarette Revenue Return
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1
2Illinois Department of Revenue
REV 1
RC-6-A-X
E S ___/___/___
Amended Out-of-State Cigarette Revenue Return
NS
DP
CA
Read this information first
Do not write above this line.
Station no. 067
Do not send any payment with Form RC-6-A-X. Keep a copy of your completed Form RC-6-A-X for your records.
Step 1: Identify your business
1
5
Account ID:____ ____ ____ ____ ____ ____ ____ ____
For what tax period are you filing this return?
Month/Year: ___ ___/___ ___ ___ ___
2
License no.: U - ___ ___ ___ ___ ___
3
6
Business name: ________________________________________________________
Check here if your address has changed.
4
7
Business address: ______________________________________________________
Is this a final (you are no longer in business)
Number and street
return?
yes
no
________________________________________________________________
_______
City
State
ZIP
Step 2: Report your cigarette stock -
Figures as they should have been reported
Number of Cigarettes
,
,
,
8
8
Total purchase of Illinois stamped cigarettes from another licensed distributor (Sch. CC)
______
_________
_________
_________
,
,
,
9
9
Total of Illinois stamped cigarettes returned to manufacturers
______
_________
_________
_________
,
,
,
10
10
Total of other deductions (Sch. CH)
______
_________
_________
_________
,
,
,
11
11
Total of unstamped/non-Illinois stamped cigarettes shipped into Illinois (Sch. CK)
______
_________
_________
_________
,
,
,
12
12
Net total of Illinois stamped cigarettes shipped into Illinois (Sch. CL)
______
_________
_________
_________
1 3
13 $
Value of Illinois stamps affixed to cigarettes you sold - Multiply Line 12 by appropriate mill rate.
________________________|_________
Step 3: Report your Illinois cigarette revenue stamp usage -
Figures as they should have been reported
Dollar value
14
14
$
Value of all stamps on hand at the beginning of the month
________________________|_________
15
15 $
Value of unaffixed stamps transferred from another licensed distributor
________________________|_________
16
16 $
Value of stamps purchased during the month (Sch. CF-1, Step 2)
________________________|_________
17
17 $
Value of stamps affixed when purchased - Multiply Step 2, Line 8, by appropriate mill rate.
________________________|_________
18
Add Lines 14 thru 17. This is the value of stamps on hand at the beginning
of the month plus purchases made during the month.
18 $
________________________|_________
19
19 $
Value of unaffixed stamps transferred to another licensed distributor
________________________|_________
20
20 $
Value of stamps returned for credit
________________________|_________
21
21 $
Add Lines 19 & 20. This is your total deductions.
________________________|_________
22
22 $
Subtract Line 21 from Line 18. This is the total value of stamps to be accounted for.
________________________|_________
23
23 $
Value of affixed stamps on hand at the end of the month (Sch. CF, Part 3a)
________________________|_________
2 4
24 $
Value of unaffixed stamps on hand at the end of the month (Sch. CF, Part 3b)
________________________|_________
25
25 $
Add Lines 23 and 24. This is the value of all stamps on hand at the end of the month.
________________________|_________
26
26 $
Subtract Line 25 from 22. This is the value of affixed stamps sold during the month.
________________________|_________
Step 4: Check the reason you are filing this amended return
❑
I made an error on a schedule or attachment.
❑
I should have taken a deduction for____________________________________________________________________________
❑
The original License no. was incorrect. The incorrect License no. is U - ___ ___ ___ ___ ___.
❑
The original reporting period was incorrect. The incorrect reporting period is ___________________________.
❑
Other. Please explain. ______________________________________________________________________________________
________________________________________________________________________________________________________
Step 5: Sign below
Under penalties of perjury, I state that I have examined this return and all accompanying schedules and, to the best of my knowledge, it is
true, correct, and complete. I also state that such information is taken from the books and records of the business for which this return is filed.
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Owner or officer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Preparer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
*043501110*
RC-6-A-X (R-04/10)
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