Form St-6 - Claim For Prior Overpayment / Request For Action On A Credit Memorandum Form
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Illinois Department of Revenue
ST-6
Claim for Prior Overpayment /
Request for Action on a Credit Memorandum
General information
Everyone must complete Parts 1 and 6.
If you are filing a claim for a prior overpayment on your account, you must complete Parts 2 and 3.
If you have been issued a credit memorandum and you are requesting a transfer or a cash refund, you must complete Parts 4 and 5.
Do not write above this line.
Part 1: Identify your business
1
IBT no.
____________________________________________
Mark with an “X” only if the address is different from the
Illinois business tax number
address on your original return, then complete Item 3 below.
2
3
Business name ______________________________________
Mailing address
______________________________________
Number and street
_____________________________________________________
City
State
ZIP
Part 2: Tell us why are you filing this claim for prior overpayment
Check one of the following reasons.
(Note: Illinois law requires us to convert a prior overpayment to a credit memorandum before taking other action.)
4 _____ I have a balance of prior overpayment that I want to have
5 _____ I have a balance of prior overpayment that I want to have
converted to a credit memorandum and transferred
converted to a credit memorandum.
to another Illinois business tax (IBT) number.
That IBT number is __ __ __ __ __ __ __ __.
6 _____ I have a balance of prior overpayment that I want to have
converted to a credit memorandum then converted to cash.
Part 3: Tell us the amount of the prior overpayment
7 What is the total amount of prior overpayment you are claiming in Part 2?
$______________________________
Part 4: Tell us what action you are requesting for this credit memorandum
Check one of the following reasons.
8 _____ I have a credit memorandum that I want to have
9 _____ I have a credit memorandum that I want to have
transferred to another Illinois business tax (IBT) number.
converted to cash.
That IBT number is __ __ __ __ __ __ __ __.
Part 5: Tell us the amount of the credit memorandum
10 What is the total amount of credit memorandum on which you are requesting action in Part 4?
$______________________________
Part 6: Sign below
Under penalties of perjury, I state that I have examined this claim or request for action on a credit memorandum and, to the best of my
knowledge, it is true, correct, and complete.
(
)
-
Owner, partner, or officer’s signature
Title and company affiliation
Phone
Date
(
)
-
Paid preparer’s signature
Phone
Date
Mail to:
SALES TAX PROCESSING DIVISION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19013
SPRINGFIELD IL 62794-9013
This form has been authorized by the Illinois Retailers’ Occupation Tax Act. Disclosure of this information is REQUIRED. Failure
ST-6 front (R-3/02)
to provide information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2734
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