Form Ds-1-X Amended Dry-Cleaning Solvent Tax Return - Illinois Page 2
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1
2Step 4: Correct your financial information
Column A
Column B
Most recent figures filed
Figures as they should
have been filed
Tax on sales
14 For chlorine-based solvents
a
14a
14a
Write the number of gallons sold.
_______________________
_______________________
b
14b
14b
Write the number of gallons of sold tax-free to qualifying facilities.
_______________________
_______________________
c
14c
14c
Subtract Line 14b from Line 14a.
_______________________
_______________________
d
14d
14d
Multiply Line 14c by $10.00. This is your tax on chlorine-based solvents.
_______________________
_______________________
15
For petroleum-based solvents
a
15a
15a
Write the number of gallons sold.
_______________________
_______________________
b
15b
15b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
_______________________
c
15c
15c__
Subtract Line15b from Line 15a.
_______________________
_____________________
d
15d
15d
Multiply Line 15c by $2.00. This is your tax on petroleum-based solvents.
_______________________
_______________________
16
For green solvents sold that are not for use in virgin facilities
a
16a
16a
Write the number of gallons sold.
_______________________
_______________________
b
16b
16b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
_______________________
c
16c
16c
Subtract Line 16b from Line 16a.
_______________________
_______________________
d
16d
16d
Multiply Line 16c by $1.75. This is your tax on these green solvents.
_______________________
_______________________
17
For green solvents sold for use in virgin facilities
a
17a
17a
Write the number of gallons sold.
_______________________
_______________________
b
17b
17b
Write the number of gallons sold tax-free to qualifying facilities.
_______________________
_______________________
c
17c
17c
Subtract Line 17b from Line 17a.
_______________________
_______________________
d
17d
17d_
Multiply Line 17c by $0.35. This is your tax on these green solvents.
_______________________
______________________
Tax on purchases from unregistered out-of-state suppliers
18
18
18
Write the number of gallons of chlorine-based solvents.
_______________________
_______________________
19
19
19
Multiply Line 18 by $10.00. This is your tax on chlorine-based solvents.
_______________________
_______________________
20
20
20
Write the number of gallons of petroleum-based solvents.
_______________________
_______________________
21
21
21
Multiply Line 20 by $2.00. This is your tax on petroleum-based solvents.
_______________________
_______________________
22
Write the number of gallons of green solvents purchased that
22
22
are not for use in a virgin facility.
_______________________
_______________________
23
23
23
Multiply Line 22 by $1.75. This is your tax on these green solvents.
_______________________
_______________________
24
Write the number of gallons of green solvents purchased for
24
24
use in a virgin facility.
_______________________
______________________
25
25
25
Multiply Line 24 by $0.35. This is your tax on these green solvents.
_______________________
_______________________
Total tax
26
Add Lines 14d, 15d, 16d, 17d, 19, 21, 23, and 25.
26
26
This is your total amount due.
_______________________
_______________________
27
27
Write the total amount you have paid.
_______________________
28
If Line 27 is greater than Line 26, Column B, subtract Line 26 from Line 27.
28
This is the amount you have overpaid. Stop here and sign this return in Step 5.
_______________________
29
If Line 27 is less than Line 26, Column B, subtract Line 27 from Line 26.
This is the amount you have underpaid. Please pay this amount and
29
sign this return in Step 5.
_______________________
Make your check payable to “Illinois Department of Revenue.”
Please write the amount you are paying on the line provided on the front of this return.
Step 5: Sign below
Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.
______________________________________________________ ____________________________________________________
Taxpayer's signature
Telephone
Date
Tax preparer's signature
Telephone
Mail your completed return to:
DRY-CLEANING SOLVENT TAX
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19034
SPRINGFIELD IL 62794-19034
DS-1-X back (R-3/04)
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