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 1

Maintenance Fee (TIMF) Return

E S ___/___/___

NS DP CA

Station no. 060

Step 1: 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)?

yes no

Address: ____________________________________________

Number and street

*089601110*

___________________________________________________

City

State

ZIP

Step 2: Figure your TIMF due -

F igures as they should have been filed

Net gross charges:

Gross charges (defined in instructions) billed during this liability period.

_______________________

Amount you received during this liability period on credit previously extended.

_______________________

1 0

Add Lines 8 and 9. This amount is your total gross charges.

_______________________

Deductions:

11a

Gross charges billed to the federal government

_______________________

11b

Gross charges billed for wireless telecommunications

_______________________

11c

Fee-free sales billed to resellers

_______________________

11d

Other. Explain: _____________________________________

_______________________

1 2

Add Lines 11a through 11d. This amount is your total deduction.

_______________________

1 3

Subtract Line 12 from Line 10. This amount is your net gross charges subject to the State TIMF.

_______________________

Multiply Line 13 by 0.5% (.005). This is your State TIMF due.

_______________________

If you file this return and pay the amount due by the due date, multiply Line 14 by 2% (.02).

_______________________

Subtract Line 15 from Line 14.

_______________________

Credit you wish to apply.

_______________________

Subtract Line 17 from Line 16. This is your net fee due.

_______________________

1 9

Total amount you have paid for this reporting period.

_______________________

2 0

If Line 19 is greater than Line 18, subtract Line 18 from Line 19. This is the amount you have overpaid.

_______________________

2 1

If Line 19 is less than Line 18, subtract Line 19 from Line 18. This is the amount you have underpaid.

Pay this amount. Make your check payable to “Illinois Department of Revenue.”

_______________________

Step 3: 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 fee.

• If you checked this box, did you collect the overpaid fee from your customer?

yes

• If you checked “yes,” did you unconditionally refund the overpaid fee?

yes

❑

I made a computation error that resulted in underpayment of 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 4: 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-04/10)

This form is authorized by the Telecommunications Municipal Infrastructure Maintenance Fee Act. Disclosure of this information is REQUIRED.

Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center.

IL-492-3781

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