Form Rc-6-A-X - Amended Out-Of-State Cigarette Revenue Return - 2002
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Illinois Department of Revenue
REV 1
RC-6-A-X
Amended Out-of-State Cigarette Revenue Return
E S ___/___/___
NS
DP
CA
Do not write above this line.
Read this information first
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.
Station no. 067
Step 1: Identify your business
1
5
Illinois Business Tax number (IBT no.):____ ____ ____ ____ - ____ ____ ____ ____
For what tax period are you filing this return?
___ ___/ ___ ___ ___ ___
Month
Year
U –
2
License no.:
________________________________________________________
6
Check here if your address has changed.
3
Business name: _______________________________________________________
4
7
Business address:______________________________________________________
Is this a final return?
yes
no
Number and street
“Final” indicates you will no longer conduct
___________________________________________________________________
business.
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)
______
_________
_________
_________
13
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)
________________________|_________
24
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 IBT no. was incorrect. The incorrect IBT no. is __ __ __ __ - __ __ __ __.
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
This form is authorized by the Cigarette Use Tax Act. Disclosure of this information is REQUIRED. Failure to provide
RC-6-A-X (N-01/02)
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-4251
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