Form Rc-6-A-W - Out-Of-State Cigarette Revenue Return Worksheet 2010

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Illinois Department of Revenue
RC-6-A-W
Out-of-State Cigarette Revenue Return Worksheet
Read this information first -
Report old and multiple tax rates on cigarettes or cigarette tax stamps that are pur-
chased, sold, transferred, or returned using Form RC-6-A-W and see additional instructions on Form RC-6-A.
Make a photocopy of your completed Form RC-6-A-W for your records and attach the original to Form RC-6-A.
Step 1:
Identify your business
Name : _ _ ___________________________________________ Account ID: __ __ __ __ __ __ __ __
Address:___________________________________________ License no.: U - ___ ___ ___ ___ ___
Number and street
__________________________________________________ Tax period: __ __ / __ __ __ __
City State
ZIP
Month Year
Step 2:
Report your cigarette stamp information by mill rate
1
Number of cigarettes purchased with Illinois tax stamps affixed
,
,
,
a at the rate of 29 mills.
a ______
_________
_________
_________
,
,
,
b at the rate of 49 mills.
b ______
_________
_________
_________
,
,
,
1
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 8).
______
_________
_________
_________
2
Number of cigarettes with Illinois tax stamps affixed that you returned to manufacturers
,
,
,
a at the rate of 29 mills.
a ______
_________
_________
_________
,
,
,
b at the rate of 49 mills.
b ______
_________
_________
_________
,
,
,
2
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 9.
______
_________
_________
_________
3
Number of cigarettes you sold that were subject to tax
,
,
,
a at the rate of 29 mills.
a ______
_________
_________
_________
,
,
,
b at the rate of 49 mills.
b ______
_________
_________
_________
,
,
,
3
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 12).
______
_________
_________
_________
4
Figure the amount of the tax on the cigarettes you sold
$
a Multiply Line 3a by .029.
a
_________________________________
$
b Multiply Line 3b by .049.
b
_________________________________
4 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 13).
_________________________________
5
Write the value of Illinois tax stamps on hand at the beginning of the month
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
5 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 14).
_________________________________
6
Value of the unaffixed Illinois tax stamps transferred to you by another licensed distributor
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
6 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 15).
_________________________________
7
Value of the Illinois tax stamps affixed to packages you purchased
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
7 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 17).
_________________________________
8
Value of the unaffixed Illinois tax stamps you transferred to another licensed distributor
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
8 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 19).
_________________________________
9
Value of all Illinois tax stamps affixed that you had on hand at the end of the month
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
9 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 23).
_________________________________
10
Value of all unaffixed Illinois tax stamps that you had on hand at the end of the month
$
a at the rate of 29 mills.
a
_________________________________
$
b at the rate of 49 mills.
b
_________________________________
10 $
Add Lines a and b for a total of both rates (write here and on Form RC-6-A, Line 24).
_________________________________
*043401110*
RC-6-A-W Page 1 (R-04/10)

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