Form Rpu-21 - Utility Tax Multiple-Location Schedule - 2001

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Illinois Department of Revenue
RPU-21
Utility Tax Multiple-Location Schedule
Sheet no. ___ of ___
Step 1: Identify your business
1
5
IBT number
___ ___ ___ ___ - ___ ___ ___ ___
Liability period
the month of __ __/__ __ __ __.
Illinois business tax number
the quarter ending __ __/__ __ __ __.
(Check one.)
2
Certificate of registration number _______________________
the year __ __ __ __.
3
6
Name _____________________________________________
Utility tax or fee
Gas Revenue Tax
Electricity Excise Tax
(Check one.)
4
Address ____________________________________________
Public Utilities Revenue Tax
(liabilities prior
Number and street
to August 1, 1998)
___________________________________________________
Telecommunications Excise Tax
City
State
ZIP
Telecom. Infrastructure Maintenance Fee
Step 2: Complete the following information for each Illinois location
1
2
3
4
5
Address
Certificate
Therms or
Receipts or net
(Number and street)
number
Name
kilowatt-hours
gross charges
(City)
____________
_________________________ ____________________________
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_________________________ ____________________________
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_________________________ ____________________________
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_________________________ ____________________________
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_________________________ ____________________________
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_________________________ ____________________________
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____________________________
Totals
_______________
______________
RPU-21 front (R-1/01)

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