Form St-14-X - Amended Chicago Soft Drink Tax Return (2010) Page 2
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1
2Step 3: Correct your fi nancial information
Column A
Column B
When writing your fi gures, please round to the nearest whole dollar.
Most recent fi gures fi led
Figures as they should
have been fi led
1
1
1
Write your total Chicago soft drink receipts.
________________________
________________________
2
2
2
Write your total deductions.
________________________
________________________
3
3
3
Subtract Line 2 from Line 1. This amount is your taxable receipts.
________________________
________________________
4
4
4
Multiply Line 3 by 3 percent (.03). This is your tax due on receipts.
________________________
________________________
5
5
5
Discount (See instructions.)
________________________
________________________
6
6
6
Subtract Line 5 from Line 4. This is your payment due.
________________________
________________________
7
7
Write the total amount you have paid.
________________________
8
If Line 7 is greater than Line 6, Column B, write the difference.
8
This is the amount you have overpaid. Go to Step 4.
________________________
9
If Line 7 is less than Line 6, Column B, write the difference.
9
This is the amount you have underpaid. Please pay this amount. Go to Step 4.
________________________
Make your check payable to “Chicago Soft Drink Tax.”
Please write the amount you are paying on the line provided on the front of this return.
Step 4: Sign below
Under penalties of perjury, I state that I have examined this return, and to the best of my knowledge, it is true, correct, and complete. Under
penalties of perjury, I state that I have unconditionally refunded to my customer(s) any overpaid tax that I collected from my customer(s) and
am claiming as an overpayment on this return.
Taxpayer’s signature
Title
Phone
Date
Title
Preparer’s signature
Phone
Date
Mail this return and payment you owe to:
CHICAGO SOFT DRINK TAX ADMINISTRATION
PO BOX 19034
SPRINGFIELD IL 62794-9034
*010322110*
ST-14-X back (R-1/10)
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