Form Rg-1 - Gas Tax Return - 2010
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Illinois Department of Revenue
REV 2
RG-1
Gas Tax Return
E S ___/___/___
Station no. 051
NS DP CA
Step 1: Identify yourself or business
Do not write above this line.
1
6
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
Complete to indicate the tax period for
which you are filing this return:
G
2
Month of __ __/__ __ __ __
License no.: ___ - ___ ___ ___ ___ ___
Quarter ending __ __/__ __ __ __
3
Year __ __ __ __
Taxpayer’s name: _ _____________________________________________________
7
Check here if your address has changed.
4
Business name: _ ______________________________________________________
5
Address:________ _ ____________________________________________________
8
Is this a final (you are no longer in business)
Number and street
return? yes no
____________________________________________________________________
City State ZIP
Step 2: Figure your receipts or purchases subject to tax
9
9
Receipts (defined on back) from sales or purchases.
___________|___
10
Suppliers only - Deductions (only tax-exempt receipts you included on Line 9).
a
10a
Receipts from interstate commerce
___________|___
b
10b
Receipts from rebillable service (sale for resale)
___________|___
c
10c
Other. Explain:______________________________________________________
___________|___
11
11
Suppliers only - Add Lines 10a through 10c. This amount is your total deduction.
___________|___
12
12
Subtract Line 11 from Line 9. This amount is your receipts or purchases subject to tax.
___________|___
Step 3: Figure your therms of gas subject to tax
13
13
Total therms of gas taxed on a per-therm basis.
___________|___
14
Suppliers only - Deductions (only tax-exempt therms you included on Line 13).
a
14a
Therms of gas sold or distributed in interstate commerce
___________|___
b
14b
Therms of gas to be rebilled service (sale for resale)
___________|___
c
1 4c
Other. Explain:______________________________________________________
___________|___
15
15
Suppliers only - Add Lines 14a through 14c. This amount is your total deduction.
___________|___
16
16
Subtract Line 15 from Line 13. This amount is your therms of gas subject to tax.
___________|___
16a
a Total therms of gas taxed on a per therm basis subject to Gas Revenue Tax.
___________|___
16b
b Total therms of gas taxed on a per therm basis subject to Gas Use Tax.
___________|___
Step 4: Figure your tax due
17
17
Multiply Line 12 by 5% (.05). This is the tax on your receipts or purchases.
___________|___
18 a
18a
Multiply Line 16a by 2.4¢ (.024) per therm of gas. This is the Gas Revenue Tax per therms.
___________|___
b
18b
Multiply Line 16b by 2.4¢ (.024) per therm of gas. This is the Gas Use Tax per therms.
___________|___
19
19
Add Lines 17, 18a and 18b. This is the total gas tax due.
___________|___
20
20
Suppliers only - See instructions for Gas Use Tax collection discount information. Self-assessors, write “0”.
___________|___
21
21
Subtract Line 20 from Line 19. This is your tax due.
___________|___
22
22
If you pay on a quarter-monthly basis, write the amount you paid in estimated payments. If not, write “0.”
___________|___
23
23
If Line 22 is greater than Line 21, subtract Line 21 from Line 22. This is the amount you overpaid. Go to Step 5.
___________|___
24
24
If Line 22 is less than Line 21, subtract Line 22 from Line 21. This is the balance due.
___________|___
25
25
Write the total credit you wish to apply.
___________|___
26
26
Subtract Line 25 from Line 24 - pay this amount. Make your check payable to “Illinois Department of Revenue.”
___________|___
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.
_____________________________
________________________ (____)____-___________
____/____/________
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 6: Mail your return
Mail your completed Form RG-1, payment, and attachments to
GAS TAX
Note: If you prefer, you can file Form RG-1
ILLINOIS DEPARTMENT OF REVENUE
*042301110*
using our WebFile program at tax.illinois.gov.
PO BOX 19019
SPRINGFIELD IL 62794-9019
RG-1 (R-04/10)
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