Form Rlg-14 - Order-Invoice For Real Estate Transfer Tax Stamps

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Illinois Department of Revenue
RLG-14
Order-Invoice for Real Estate Transfer Tax Stamps
Part 1:
Purchaser information
__ __ __ __ __ __ __ __
Account ID:
County:___________________
License no.: RE - __ __ __ __ __
Sold to name: ___________________________________________
Title: ______________________
Date: _____/_____/__________
Address: _______________________________________________
Delivery:
Mail
City:__________________________
ZIP Code:_______________
Picked up by _______________________________
Authorization: ___________________________________________
Signature of county official
Part 2:
Stamp information
County stamp
Denomination
Quantity
For Department use only
Amount
inventory
needed
(Stamp serial numbers)
.25
.50
.75
1.00
2.00
3.00
4.00
5.00
7.50
10.00
20.00
30.00
40.00
50.00
75.00
100.00
300.00
500.00
750.00
1,000.00
5,000.00
10,000.00
50,000.00
a
Total stamp value: ____________________________
Part 3:
Meter setting information
Meter number: _______________ Make/model number: ________________________
________________________________________
Signature of a county representative verifying register reading
Reading before setting — completed by the county
Reading after setting — completed by the IDOR
1
5
Ascending register: ____________________________________
Ascending register: _____________________________________
2
6
Descending register: ____________________________________
Descending register: ____________________________________
3
Meter amount ordered: _________________________________
4
7
Total - Add Lines 1, 2, and 3: ____________________________
Total - Add Lines 5 and 6 (must equal Line 4): ________________
Part 4:
Balance due
b
b
Total value — add Part 2, Line a and Part 3, Line 3 amounts:
______________________
c
c
For option 2 purchases, enter .66666666667 of Line b:
______________________
d
d
Credit:
______________________
e
e
Balance due — Line b or Line c minus Line d:
______________________
Do not write below this line
Department use only:
Completed by:_________________________
Reviewed by:_________________________
Posted by:________________________
Date: ____/____/________
Date: ____/____/________
Date: ____/____/________
RLG-14 front (R-06/14)
This form is authorized by the Real Estate Transfer Tax Act. Disclosure of information is REQUIRED. Failure to comply may result in a penalty.
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