Form Eda-117-R - Multiple Location Schedule For Eda-98-R

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Illinois Department of Revenue
EDA-117-R Multiple Location Schedule
(attach to EDA-98-R)
_______________________________________________________________________________
Illinois business account ID: _ _ _ _ - _ _ _ _
Processing Period:________________________
Location code:
General merchandise
4b
Site name:
Food, drugs, and
medical appliances
5b
Address:
Sales at other rates
8b
Penalty (prior to 12/93)
26a
Late-fi le penalty
26b
Negligence penalty
26c
Fraud penalty
26d
Late-payment penalty
(12/03 and after)
26e
Interest on tax
27a
Interest on late-fi ling
penalty
27b
Interest on negligence/
fraud penalty
27c
Location code:
General merchandise
4b
Site name:
Food, drugs, and
medical appliances
5b
Address:
Sales at other rates
8b
Penalty (prior to 12/93)
26a
Late-fi le penalty
26b
Negligence penalty
26c
Fraud penalty
26d
Late-payment penalty
(12/03 and after)
26e
Interest on tax
27a
Interest on late-fi ling
penalty
27b
Interest on negligence/
fraud penalty
27c
Completed by________________________________________________ Date_____/_____/_____ Page_____of________
EDA-117-R (R-5/08) IL492-4531
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