Form Ds-1-X Amended Dry-Cleaning Solvent Tax Return - Illinois
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Illinois Department of Revenue
DS-1-X
Amended Dry-Cleaning
Station 253
FORM 164 REV 02
Solvent Tax Return
E S
___/___/___
NS DP CA RC
Read this information first
Do not write above this line.
Everyone must complete Steps 1, 2, and 5.
Amount you are paying: $___________________________
You must also complete
• Step 3 if you believe you have overpaid and
Make your check payable to “Illinois Department of Revenue.”
• Step 4 if you are changing financial information.
Step 1: Identify your business
“X” only if your address is different from the address on your
1
IBT no. ___ ___ ___ ___ - ___ ___ ___ ___
original return and complete item 4 below.
Illinois business tax number
2
4
Amended tax period__________________________________
Mailing address___________________________________
Number and street
3
Business name______________________________________
___________________________________________________
City
State
ZIP
Step 2: Check the reason you are correcting your return
5
___ I paid tax on receipts that I shouldn’t have because I sold
6
___ I put an amount on the wrong line on Form DS-1.
dry cleaning solvents
a
___ to another Illinois business for resale.
7
___ I overcollected tax from my customer.
(Business’ IBT no. _________________________)
8
___ I made a computational error.
b
___ to an out-of-state customer, which was a sale in
interstate commerce. The solvent was delivered to
9
___ The original IBT number was incorrect. The correct IBT
a location outside Illinois.
number is ___________________________________.
c
___ to an exempt organization.
10
___ The original tax period was incorrect. The correct tax
(Tax-exempt no. E-_________________________)
period is ___________________________________.
d
11
___ that were returned by my customer.
___ Other. Please explain.__________________________
e
___ that were exempt for another reason. Please explain.
___________________________________________
_________________________________________
____________________________________________
_________________________________________
____________________________________________
_________________________________________
____________________________________________
Step 3: If you are claiming an overpayment, answer the following questions
12
Did you collect the overpaid tax from your customer?
___ yes
___ no
13
If yes, did you unconditionally refund the overpaid tax?
___ yes
___ no
Please turn page over to complete Steps 4 and 5.
This form is authorized by the Dry Cleaner Environmental Response Trust Fund Act. Disclosure of this information is REQUIRED.
Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-3816
DS-1-X front (R-3/04)
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