Form St-14-X - Amended Chicago Soft Drink Tax Return
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ST-14-X
Amended Chicago Soft Drink
Tax Return
REV 03
FORM 103
E S _____/____/_____
NS DP CA RC
Do not write above this line.
Read this information first
•
If you are making a payment with this return,
write the amount you are paying here.
$___________________________
Make your payment to “Chicago Soft Drink Tax.”
•
If you are claiming an overpayment on this return and you collected the overpaid tax from your customer(s), you must
refund the tax to your customer(s) before filing this return. When you complete this return, you must state, under penalties
of perjury, in Step 4, that you unconditionally refunded the overpaid tax to your customer(s).
Step 1: Identify your business
1
Account ID: ____ ____ ____ ____ - ____ ____ ____ ____
2
Reporting period you are amending:
__ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __
Month Day
Year
Month Day
Year
3
Business name _______________________________________
Step 2: Mark the reason why you are filing an amended return.
Check any appropriate lines below.
1
3
____ I took a deduction on my original return that was not allowed
____ I put an amount on the wrong line on Form ST-14.
4
____ I overcollected soft drink tax from my customer.
or was too large.
2
5
____ I should have taken a deduction or a larger deduction on my
____ I made a computational error.
6
original return because I sold soft drinks
____ The original Account ID number was incorrect. The
a
____ to another Illinois business for resale.
correct Account ID number is ___________________.
7
(Business’ Account ID no. ____________________)
____ The original reporting period was incorrect. The
b
____ to an out-of-state customer, which was a sale in
correct reporting period is ______________________.
8
interstate commerce. The soft drinks were delivered
____ Other. Please explain. ________________________
to a location outside Illinois.
___________________________________________
c
____ to an exempt organization.
___________________________________________
(Tax-exempt no. E- _________________________)
___________________________________________
d
____ that were returned by my customer.
___________________________________________
e
____ that were exempt for another reason. Please
___________________________________________
explain. ___________________________________
___________________________________________
_________________________________________
___________________________________________
Please turn page to complete Parts 3 and 4
This form is authorized by ordinance of the city council of the city of Chicago and by related tax acts.
Disclosure of this information is REQUIRED. Failure to provide information could result in a penalty.
*710331110*
ST-14-X (R-05/17)
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