Form Rt-10-X - Amended Telecommunications Infrastructure Maintenance Fees Return - 2003
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Illinois Department of Revenue
RT-10-X
Amended Telecommunications Infrastructure
REV 1
E S ___/___/___
Maintenance Fees Return
NS
DP
CA
Station no. 060
Do not write above this line.
Step 1: Identify your business
5
Check the appropriate box and complete the information to
1
Illinois Business Tax number (IBT no.): __ __ __ __ - __ __ __ __
indicate the fee period for which you are filing this return:
Month of
__ __/__ __ __ __
T I
2
Certificate of registration no.: ___ ___ - ___ ___ ___ ___
Quarter ending __ __/__ __ __ __
6
Check here if your address has changed.
3
Name: ______________________________________________
7
Is this a final return?
yes
no
"Final” indicates you will no longer conduct business. If
4
Address: ____________________________________________
Number and street
"yes," complete the following information:
I sold my business on _ _/_ _/_ _ _ _.
___________________________________________________
City
State
ZIP
I discontinued business on _ _/_ _/_ _ _ _.
Step 2: Figure your telecommunications infrastructure maintenance fees (TIMFs) due
Figures as they should have been filed
Net gross charges subject to the State TIMF:
8
8
Gross charges (defined in instructions) billed during this liability period.
_______________________
9
9
Amount you received during this liability period on credit previously extended.
_______________________
10
10
Add Lines 8 and 9. This amount is your total gross charges.
_______________________
11
Deductions:
a
11a
Gross charges billed to the federal government
_______________________
b
11b
Gross charges billed for wireless telecommunications
_______________________
c
11c
Fee-free sales billed to resellers
_______________________
d
11d
Other. Explain: _____________________________________
_______________________
12
12
Add Lines 11a through 11d. This amount is your total deduction.
_______________________
13
13
Subtract Line 12 from Line 10. This amount is your net gross charges subject to the State TIMF.
_______________________
14
14
Multiply Line 13 by 0.5% (.005). This is your State TIMF due.
_______________________
15
15
If you file this return and pay the amount due by the due date, multiply Line 14 by 2% (.02).
_______________________
16
16
Subtract Line 15 from Line 14.
_______________________
17
17
Credit you wish to apply.
_______________________
18
18
Subtract Line 17 from Line 16. This is your net fee due.
_______________________
19
19
Total amount you have paid for this reporting period.
_______________________
20
20
If Line 19 is greater than Line 18, subtract Line 18 from Line 19. This is the amount you have overpaid.
_______________________
21
If Line 19 is less than Line 18, subtract Line 19 from Line 18. This is the amount you have underpaid.
21
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
no
• If you checked “yes,” did you unconditionally refund the overpaid fee?
yes
no
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 IBT no. was incorrect. The incorrect IBT no. is __ __ __ __-__ __ __ __.
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
This form is authorized by the Telecommunications Municipal Infrastructure Maintenance Fee Act. Disclosure of this information is REQUIRED.
RT-10-X (R-01/03)
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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