Form St-14-X - Amended Chicago Soft Drink Tax Return (2010)
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ST-14-X
Amended Chicago Soft Drink Tax Return
Rev 02 Form 103
E S __ __/__ __/__ __ __ __
NS
DP
CA
RC
Read this information fi rst
Do not write above this line.
•
If you are making a payment with this return,
write the amount you are paying here.
$___________________________
Make your check payable to “Illinois Department of Revenue.”
•
If you are claiming an overpayment on this return and you collected the overpaid tax from your customer(s), you must
refund the tax to your customer(s) before fi ling this return. When you complete this return, you must state, under penal-
ties of perjury, in Step 4, that you unconditionally refunded the overpaid tax to your customer(s).
Step 1: Identify your business
1
Account ID: ____ ____ ____ ____ - ____ ____ ____ ____
2
Reporting period you are amending:
__ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __
Month Day
Year
Month Day
Year
3
Business name _______________________________________
Step 2: Mark the reason you are fi ling an amended return
1
3
____ I took a deduction on my original return that was not
____ I put an amount on the wrong line on Form ST-14.
4
allowed or was too large.
____ I overcollected soft drink tax from my customer.
2
5
____ I should have taken a deduction or a larger deduction
____ I made a computational error.
6
on my original return because I sold soft drinks
____ The original account ID was incorrect. The correct
a
____ to another Illinois business for resale. Write the
account ID is ____________________________________.
7
business’ account ID ________________________.
____ The original reporting period was incorrect. The correct
b
____ to an out-of-state customer and the sale was
reporting period is _________________________________.
8
in interstate commerce. The soft drinks were
____ Other. (Please explain)
delivered to a location outside Illinois.
_______________________________________________
c
____ to an exempt organization. Write the tax-exempt
_______________________________________________
no. E- ____________________________________.
_______________________________________________
d
____ that were returned by my customer.
_______________________________________________
e
____ that were exempt for another reason. Please
_______________________________________________
explain. ___________________________________
_______________________________________________
_________________________________________
_______________________________________________
Please turn page to complete Steps 3 and 4.
This form is authorized by ordinance of the city council of the city of Chicago and by related tax acts. 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-492-3387
*010321110*
ST-14-X front (R-1/10)
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