Form Rc-27-B - Declaration Of Unaffixed Cigarette Stamps

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Illinois Department of Revenue
RC-27-B
Declaration of Unaffixed Cigarette Stamps
Do not write above this line.
Step 1: Identify yourself
Name _________________________________________________
IBT no. ___ ___ ___ ___ ___ ___ ___ ___
Address ________________________________________________
License no. _____________________________________________
Number and street
________________________________________________
City
State
ZIP
Step 2: Tell us about the unaffixed stamps in your inventory
1
1
Write the number of unaffixed 22¢ stamps, and multiply that number by the tax rate.
_____________ X 22¢ =
$_____________
2
2
Write the number of unaffixed 44¢ stamps, and multiply that number by the tax rate.
_____________ X 44¢ =
$_____________
3
3
Write the number of unaffixed 55¢ stamps, and multiply that number by the tax rate.
_____________ X 55¢ =
$_____________
4
4
Add Lines 1, 2, and 3. This amount is the total gross value of your unaffixed cigarette stamps.
$_____________
Step 3: Sign below
I certify that at the close of business on December 14, 1997, there were on hand or in storage for our account unaffixed Illinois Cigarette Tax
stamps as identified above.
Taxpayer signature _______________________________________
Title _________________________________
Date ____________
Witness, if available ______________________________________
IDOR employee
This form is authorized by the Illinois Cigarette Tax Act. Disclosure of this information is REQUIRED. Failure to provide
RC-27-B front (N-11/97)
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-1479
Illinois Department of Revenue
RC-27-B
Declaration of Unaffixed Cigarette Stamps
Do not write above this line.
Step 1: Identify yourself
Name _________________________________________________
IBT no. ___ ___ ___ ___ ___ ___ ___ ___
Address ________________________________________________
License no. _____________________________________________
Number and street
________________________________________________
City
State
ZIP
Step 2: Tell us about the unaffixed stamps in your inventory
1
1
Write the number of unaffixed 22¢ stamps, and multiply that number by the tax rate.
_____________ X 22¢ =
$_____________
2
2
Write the number of unaffixed 44¢ stamps, and multiply that number by the tax rate.
_____________ X 44¢ =
$_____________
3
3
Write the number of unaffixed 55¢ stamps, and multiply that number by the tax rate.
_____________ X 55¢ =
$_____________
4
4
Add Lines 1, 2, and 3. This amount is the total gross value of your unaffixed cigarette stamps.
$_____________
Step 3: Sign below
I certify that at the close of business on December 14, 1997, there were on hand or in storage for our account unaffixed Illinois Cigarette Tax
stamps as identified above.
Taxpayer signature _______________________________________
Title _________________________________
Date ____________
Witness, if available ______________________________________
IDOR employee
This form is authorized by the Illinois Cigarette Tax Act. Disclosure of this information is REQUIRED. Failure to provide
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-1479
RC-27-B front (N-11/97)
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