Form Pt-11 - Limited Pull Tab And Jar Game Tax Return - 2001 Page 2
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1
2General Information
Each winning pull tab and jar game must be predetermined. The
return through the date you pay the tax. We will bill you for penalties
price for participating in such games can be no more than two
and interest. For more information about penalties and interest, see
dollars, and each prize awarded can be no more than $500. No
Publication 103, Uniform Penalties and Interest. To receive a copy of
this publication, visit our Web site at tax.illinois.gov or call us at
more than 6,000 tickets may be sold per game.
1 800 356-6302.
What is the deadline for filing this return?
In addition to imposing penalties and interest, we may suspend or
You must file this return and pay any tax due on or before the
revoke your pull tabs license.
twentieth day following the end of the occasion for which this
limited license was issued. For example, if you are filing this return
What if I have questions?
for an occasion ending March 31, it is due on or before April 20.
If you have questions about your
What if I fail to file this return and pay the
• return, call 217 782-6045
• license, call 217 524-4164
amount I owe?
weekdays between 8:00 a.m. and 4:30 p.m.
You owe a late-filing penalty if you do not file a processable return
by the due date, a late-payment penalty if you do not pay the tax
You may also write to us at: Pull Tab Tax, Illinois Department of
you owe by the date the tax is due, and a bad check penalty if
Revenue, P.O. Box 19019, Springfield, IL 62794-9019.
your remittance is not honored by your financial institution. Interest
is calculated on tax from the day after the original due date of your
Step 2: Figure your gross proceeds
(Complete Columns A through L below.)
A
B
C
D
E
F
Date of game Manufacturer’s no.
Supplier’s no.
Supplier’s name
Name of game
Form number
1
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
2
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
3
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
4
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
5
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
6
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
7
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
8
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
9
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
10
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
11
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
12
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
13
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
14
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
15
___ ___ ___
PM -___________
PS -___________
________________________ __________________ ________________
G
H
I
J
K
L
Sale price
Number of tickets
Gross proceeds
Total paid out
Profit
Serial no.
of ticket
sold per game
(Multiply Columns H and I)
(winnings)
(Column J minus Column K)
1
_____________ ____________
_______________
___________________
__________________ ___________________
2
_____________ ____________
_______________
___________________
__________________ ___________________
3
_____________ ____________
_______________
___________________
__________________ ___________________
4
_____________ ____________
_______________
___________________
__________________ ___________________
5
_____________ ____________
_______________
___________________
__________________ ___________________
6
_____________ ____________
_______________
___________________
__________________ ___________________
7
_____________ ____________
_______________
___________________
__________________ ___________________
8
_____________ ____________
_______________
___________________
__________________ ___________________
9
_____________ ____________
_______________
___________________
__________________ ___________________
10
_____________ ____________
_______________
___________________
__________________ ___________________
11
_____________ ____________
_______________
___________________
__________________ ___________________
12
_____________ ____________
_______________
___________________
__________________ ___________________
13
_____________ ____________
_______________
___________________
__________________ ___________________
14
_____________ ____________
_______________
___________________
__________________ ___________________
15
_____________ ____________
_______________
___________________
__________________ ___________________
Write the total of Column J, Gross proceeds, here
and on Step 3, Line 1, on the front of this form.
Note: If you need more space, attach additional pages using this format to list all the requested information for each game.
PT-11 back (R-5/01)
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