Form Rt-10-X - Amended Telecommunications Infrastructure Maintenance Fee (Timf) Return
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Illinois Department of Revenue
RT-10-X
Amended Telecommunications Infrastructure
REV 2
Form 896
Maintenance Fee (TIMF) Return
E S ___/___/___
NS
DP
CA
Station no. 060
Identify your business
Do not write above this line.
Check the appropriate box and complete the information to
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
indicate the fee period for which you are filing this return:
Month of
__ __/__ __ __ __
T I
License no.: ___ ___ - ___ ___ ___ ___ ___
Quarter ending __ __/__ __ __ __
Check here if your address has changed.
Name:
______________________________________________
Is this a final return (you will no longer conduct business)?
Address:
____________________________________________
yes
no
Number and street
*289601110*
___________________________________________________
City
State
ZIP
Step 1: Figure your TIMF due -
Figures as they should have been filed
Net gross charges:
1
1
Gross charges (see instructions) billed during this liability period.
_______________________
2
2
Amount you received during this liability period on credit previously extended.
_______________________
3
3
Add Lines 1 and 2. This amount is your total gross charges.
_______________________
4
Deductions:
a
4a
Gross charges billed to the federal government
_______________________
b
4b
Gross charges billed for wireless telecommunications
_______________________
c
4c
Fee-free sales billed to resellers
_______________________
d
4d
Other. Explain: _____________________________________
_______________________
5
5
Add Lines 4a through 4d. This amount is your total deduction.
_______________________
6
6
Subtract Line 5 from Line 3. This amount is your net gross charges subject to the State TIMF.
_______________________
7
7
Multiply Line 6 by 0.5% (.005). This is your State TIMF due.
_______________________
8
8
If you file this return and pay the amount due by the due date, multiply Line 7 by 2% (.02).
_______________________
9
9
Subtract Line 8 from Line 7.
_______________________
10
10
Credit you wish to apply.
_______________________
11
11
Subtract Line 10 from Line 9. This is your net fee due.
_______________________
12
12
Total amount you have paid for this reporting period.
_______________________
13
13
If Line 12 is greater than Line 11, figure your overpayment by subtracting Line 11 from Line 12.
_______________________
14
If Line 12 is less than Line 11, figure your underpayment by subtracting Line 12 from Line 11.
14
Pay this amount. Make your check payable to “Illinois Department of Revenue.”
_______________________
Step 2: Check the reason you are filing this amended return
❑
I received a Notice of Possible Overpayment or made a computation error that resulted in an overpayment of the fee.
• If you checked this box, did you collect the overpaid fee from your customer?
yes
no
• If you checked “yes,” did you unconditionally refund the overpaid fee?
yes
no
❑
I made a computation error that resulted in underpayment of the fee.
❑
I made an error on a schedule or attachment.
❑
I should have taken a deduction for ________________________________________________________________________________
❑
The original License no. was incorrect. The incorrect License no. is TI - __ __ __ __ __.
❑
The original reporting period was incorrect. The incorrect reporting period is ___________________________.
❑
Other. Please explain. ___________________________________________________________________________________________
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:
Owner or officer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________ ____/____/________
Title:
Preparer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
RT-10-X (R-11/12)
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information is
required. Failure to provide information may result in this form not being processed and may result in a penalty.
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