Form St-17-X - Amended Annual Report Of Manufacturer'S Purchase Credit Used - 2014
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Illinois Department of Revenue
ST-17-X
Amended Annual Report of
03
164
REV
FORM
Manufacturer’s Purchase Credit Used
E S _____/_____/_____
See instructions on the back.
NS
CA
Step 1:
Identify your business
1
4
Business name
_____________________________________
Illinois account ID number
___ ___ ___ ___ - ___ ___ ___ ___
2
5
Business address _____________________________________
Write the purchase year that you are amending
___ ___ ___ ___
Year
Street address
6
____________________________________________________
If you are a graphic artist, check this box.
City
State
ZIP
3
( ______ ) _______________________
Business phone number
Step 2: Identify the purchases for which MPC was used
(Do not round your figures.)
This report will replace your original filing. For each line below, report all figures as they should have been filed.
A
B
C
D
Month of
Taxable purchase price
Taxable purchase price
Total taxable
Amount of
production-related
of items purchased
of items purchased
purchase price
credit used
purchase
in Illinois
out of state
(Must not exceed 6.25%
of Column C)
1
January
$ _____________________ $ _____________________ $ _____________________ $ ___________________
2
February
$ _____________________ $ _____________________ $ _____________________ $ ___________________
3
March
$ _____________________ $ _____________________ $ _____________________ $ ___________________
4
April
$ _____________________ $ _____________________ $ _____________________ $ ___________________
5
May
$ _____________________ $ _____________________ $ _____________________ $ ___________________
6
June
$ _____________________ $ _____________________ $ _____________________ $ ___________________
7
July
$ _____________________ $ _____________________ $ _____________________ $ ___________________
8
August
$ _____________________ $ _____________________ $ _____________________ $ ___________________
9
September
$ _____________________ $ _____________________ $ _____________________ $ ___________________
10
October
$ _____________________ $ _____________________ $ _____________________ $ ___________________
11
November
$ _____________________ $ _____________________ $ _____________________ $ ___________________
12
December
$ _____________________ $ _____________________ $ _____________________ $ ___________________
Totals
$
$
_____________________
___________________
(Column C)
(Column D)
Step 3: Sign below
Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete.
__ __ /__ __ / __ __ __ __
______________________________________________________________(____)________________
Taxpayer’s signature
Daytime phone number
Date
__ __ /__ __ / __ __ __ __
______________________________________________________________(____)________________
Preparer’s signature
Preparer’s name (Please print.)
Daytime phone number
Date
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
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
ST-17-X (R-09/14)
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