Form Rg-1 - Gas Tax Return
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Illinois Department of Revenue
REV 3
Form 423
RG-1
Gas Tax Return
E S ___/___/___
Station no. 051
NS
DP
CA
Identify yourself or business
Do not write above this line.
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
Complete to indicate the tax period for which
you are filing this return:
G
Month of __ __/__ __ __ __
License no.: ___ - ___ ___ ___ ___ ___
Quarter ending __ __/__ __ __ __
Year __ __ __ __
Taxpayer’s name: ______________________________________________________
Check here if your address has changed.
Business name: _______________________________________________________
Address:________ _____________________________________________________
Is this a final (you are no longer in business)
Number and street
return?
yes
no
____________________________________________________________________
City
State
ZIP
Step 1: Figure your receipts or purchases subject to tax
1
1
Receipts (defined on instructions) from sales or purchases.
___________|___
2
Suppliers only - Deductions (only tax-exempt receipts you included on Line 1).
a
2a
Receipts from interstate commerce
___________|___
b
2b
Receipts from rebillable service (sale for resale)
___________|___
c
2c
Other. Explain:______________________________________________________
___________|___
3
3
Suppliers only - Add Lines 2a through 2c. This amount is your total deduction.
___________|___
4
4
Subtract Line 3 from Line 1. This amount is your receipts or purchases subject to tax.
___________|___
Step 2: Figure your therms of gas subject to tax
5
5
Total therms of gas taxed on a per-therm basis.
___________|___
6
Suppliers only - Deductions (only tax-exempt therms you included on Line 5).
a
6a
Therms of gas sold or distributed in interstate commerce
___________|___
b
6b
Therms of gas to be rebilled service (sale for resale)
___________|___
c
6c
Other. Explain:______________________________________________________
___________|___
7
7
Suppliers only - Add Lines 6a through 6c. This amount is your total deduction.
___________|___
8
8
Subtract Line 7 from Line 5. This amount is your therms of gas subject to tax.
___________|___
8a
a Total therms of gas taxed on a per therm basis subject to Gas Revenue Tax.
___________|___
8b
b Total therms of gas taxed on a per therm basis subject to Gas Use Tax.
___________|___
Step 3: Figure your tax due
9
9
Multiply Line 4 by 5% (.05). This is the tax on your receipts or purchases.
___________|___
10 a
10a
Multiply Line 8a by 2.4¢ (.024) per therm of gas. This is the Gas Revenue Tax per therms.
___________|___
b
10b
Multiply Line 8b by 2.4¢ (.024) per therm of gas. This is the Gas Use Tax per therms.
___________|___
11
11
Add Lines 9, 10a and 10b. This is the total gas tax due.
___________|___
12
12
Suppliers only - See instructions for Gas Use Tax collection discount information. Self-assessors, write “0”.
___________|___
13
13
Subtract Line 12 from Line 11. This is your tax due.
___________|___
14
14
If you pay on a quarter-monthly basis, write the amount you paid in estimated payments. If not, write “0.”
___________|___
15
15
If Line 14 is greater than Line 13, figure your overpayment by subtracting Line 13 from Line 14. Go to Step 4.
___________|___
16
16
If Line 14 is less than Line 13, figure your underpayment by subtracting Line 14 from Line 13.
___________|___
17
17
Write the total credit you wish to apply.
___________|___
18
18
Subtract Line 17 from Line 16 - pay this amount. Make your check payable to “Illinois Department of Revenue.”
___________|___
Step 4: 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.
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________
____/____/________
Firm:
Preparer’s signature and name of the firm or employer (if applicable)
Telephone number (include area code)
Date
Step 5: Mail your return
Mail your completed Form RG-1, payment, and attachments to
GAS TAX
Note: You can file Form RG-1 electronically
ILLINOIS DEPARTMENT OF REVENUE
*242301110*
using MyTax Illinois at tax.illinois.gov.
PO BOX 19019
SPRINGFIELD IL 62794-9019
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
RG-1 (R-11/12)
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
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