Form 7506 - Cigarette Tax Stamp Return - City Of Chicago/county Of Cook, Illinois

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CITY OF CHICAGO/COUNTY OF COOK
DEPARTMENT OF REVENUE
Cigarette Tax - 7506
Please provide missing numbers and correct any preprinted information on the form that is inaccurate.
Account Number
Site Number
Year
Month
FEIN
IBTN
County
MAILING ADDRESS:
SEND ALL PAYMENTS TO:
Chicago Department of Revenue
Cigarette Tax - Unit 7506
121 N. LaSalle Street - Room 107
Chicago, Illinois 60602
BUSINESS ADDRESS:
County Order Number ___________________________
(7 digit number)
County Registration # ___________________________
Transaction Number
2001
Return Type
4
Check if address or owner changed from prior return
Pay Location
5701
GPS Approval Number ___________________________
Remittance in a form of certified or cashier's check, cash, or postal money order must accompany stamp orders.
County
City
20 Pack
25 Pack
20 Pack
25 Pack
Section 1: Hand Stamps
multiples of 150
Multiples of 150
Multiples of 150 Multiples of 150
1.
Total Number of Packages of Cigarettes (see Instructions)
2.
Tax Rate
$2.00
$2.50
$0.68
$0.85
3.
Computed Tax (Multiply Line 1 by Line 2)
4a County Discount (Line 1 x .00225)
4b. City Discount (Line 3 x .0205)
5.
Tax Due (Subtract Line 4 from Line 3)
Section 2: Machine Rolls (Multiples of 30,000 only)
20 PACK
25 PACK
20 PACK
25 PACK
6.
Total Number of Packages of Cigarettes (see instructions)
7.
Tax Rate
$2.00
$2.50
$0.68
$0.85
8.
Computed Tax (Multiply Line 6 by Line 7)
9a. County Discount (Line 6 x .00225)
9b. City Discount (Line 8 x .0205)
10.
Tax Due (Subtract Line 9 from Line 8)
11.
Total Tax Due (Add Line 5 and Line 10)
12.
Less Credit (See Instructions)
Letter of Credit Number
13.
Tax Due (Subtract Line 12 from Line 11)
14.
Total Amount Paid (Add All Tax Due)……………………..….……………...……………………County
City
OWNER/OFFICER STATEMENT
UNDER THE PENALTY OF PERJURY, I CERTIFY THAT I HAVE EXAMINED THIS RETURN, AND IT IS TRUE, CORRECT AND COMPLETE.
SIGNATURE AND TITLE
DATE
PRINT NAME
PHONE
NOTE: YOU MUST FILL THIS FORM OUT COMPLETELY. IF ANY INFORMATION IS OMITTED, THIS RETURN WILL BE DEEMED
INCOMPLETE, AND YOU WILL BE ASSESSED ADDITIONAL PENALTIES. ACCOUNT NUMBER MUST BE ENTERED.

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