Form Rc-6-A - Out-Of-State Cigarette Revenue Return
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1
2Illinois Department of Revenue
REV 1
RC-6-A
Out-of-State Cigarette Revenue Return
E S ___/___/___
NS
DP
CA
Read this information first
Do not write above this line.
Do not send any payment with Form RC-6-A. Keep a copy of your completed Form RC-6-A for your records.
Station no. 067
Step 1: Identify your business
1
5
Account ID: ____ ____ ____ ____ ____ ____ ____ ____
For what tax period are you filing this return?
___ ___/___ ___ ___ ___
Month
Year
2
License no.: U - ___ ___ ___ ___ ___
6
Check here if your address has changed.
3
Business name: _______________________________________________________
7
Is this a final (you are no longer in business)
4
Business address: ______________________________________________________
return?
yes
no
Number and street
____________________________________________________________________
City
State
ZIP
Step 2: Report your cigarette stock
Number of cigarettes
,
,
,
8
8
Total purchase of Illinois stamped cigarettes from another licensed distributor (from Schedule CC)
______
_________
_________
_________
,
,
,
9
9
Total of Illinois stamped cigarettes returned to manufacturers
______
_________
_________
_________
,
,
,
10
10
Total of other deductions (from Schedule CH)
______
_________
_________
_________
,
,
,
11
11
Total of unstamped/non-Illinois stamped cigarettes shipped into Illinois (from Schedule CK)
______
_________
_________
_________
,
,
,
12
12
Net total of Illinois stamped cigarettes shipped into Illinois (from Schedule CL)
______
_________
_________
_________
1 3
Multiply Line 12 by the appropriate mill rate. This is the value of Illinois stamps
13 $
affixed to cigarettes you sold.
________________________|_________
Step 3: Report your Illinois cigarette revenue stamp usage
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 (from Schedule CF-1, Step 2)
________________________|_________
17
Multiply Step 2, Line 8, by the appropriate mill rate. This is the value of stamps
17 $
affixed when purchased.
________________________|_________
18
Add Lines 14, 15, 16, and 17. This is the value of stamps on hand at the beginning
of the month plus any 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 and 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.
________________________|_________
2 3
23 $
Value of affixed stamps on hand at the end of the month (from Schedule CF, Part 3a)
________________________|_________
2 4
24 $
Value of unaffixed stamps on hand at the end of the month (from Schedule 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: 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
Step 5: Mail your return or file electronically
Mail your completed Form RC-6-A and attachments to
LIQUOR AND CIGARETTE TAX SECTION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
*043301110*
SPRINGFIELD IL 62794-9019
RC-6-A (R-04/10)
This form is authorized by the Cigarette Use Tax Act. Disclosure of this information is REQUIRED. Failure to provide informa-
tion could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-3153
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