Form Rg-6 - Assistance Charges Return For Natural Gas Distributors
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Illinois Department of Revenue
RG-6
Assistance Charges Return
REV 1
for Natural Gas Distributors
RG-6 (R-04/10)
E S ___/___/___
Station 257
NS DP CA
Do not write above this line.
Step 1: Identify your business
7
1
Check here if your address has changed.
Account ID __ __ __ __ __ __ __ __
8
2
Is this a final (you are no longer in business) return? yes no
FEIN
___ ___ - ___ ___ ___ ___ ___ ___ ___
Federal employer identification number
3
License no. GA - ___ ___ ___ ___ ___
4
Name ______________________________________________
5
Address ____________________________________________
Number and street
_ __________________________________________________
City
State
ZIP
6
Liability period ___ ___/___ ___ ___ ___
Month
Year
Step 2: Figure your assistance charges due
Total number
Energy
Renewable
of accounts
Assistance Charge
Energy Charge
9
Total number of accounts to which you delivered residential gas
service and from which you collected the assistance charges
9
during this liability period.
_____________
1 0
10
Multiply Line 9 by the appropriate rate. See instructions.
__________|___
1 1
11
Multiply Line 9 by $0.05.
__________|___
12
Write the total number of accounts
• to which you delivered nonresidential gas service,
• to which you delivered less than 4 million therms of gas during
the previous calendar year, and
12
• from which you collected the assistance charges.
_____________
13
13
Multiply Line 12 by the appropriate rate. See instructions.
__________|___
14
14
Multiply Line 12 by $0.50.
__________|___
15
Write the total number of accounts
• to which you delivered nonresidential gas service,
• to which you delivered 4 million or more therms of gas during the
previous calendar year, and
15
• from which you collected the assistance charges.
_____________
16
16
Multiply Line 15 by the appropriate rate. See instructions.
__________|___
17
17
Multiply Line 15 by $37.50.
__________|___
18
18
Energy Assistance Charge - Add Lines 10, 13, and 16.
__________|___
18a
18a
Arrearage Reduction Program subtraction.
__________|___
18b
18b
Subtract Line 18a from Line 18. This is your total Energy Assistance Charge.
__________|___
19
19
Add Lines 11, 14, and 17. This amount is your total Renewable Energy Charge due.
__________|___
20
Add Lines 18b and 19. This amount is the total assistance charge due.
20
Make your check payable to “Illinois Department of Revenue.”
___________________________|_____
Step 3: 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.
_____________________________
________________
(____)____-___________
____/____/________
Title:
Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title) Telephone number (include area code) Date
_____________________________
________________
(____)____-___________
____/____/________
Firm:
Preparer’s signature and name of the firm or employer (if applicable) Telephone number (include area code) Date
Step 4: Mail your return
ASSISTANCE CHARGES
Mail your completed Form RG-6 and payment to
ILLINOIS DEPARTMENT OF REVENUE
Note: If you prefer, you can file Form RG-6
PO BOX 19019
using our WebFile program at tax.illinois.gov.
SPRINGFIELD IL 62794-9019
*936411110*
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Parent category: Financial