Form St-14-X - Amended Chicago Soft Drink Tax Return - 1997
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1
2ST-14-X
Amended Chicago Soft Drink
Tax Return
REV 01
FORM 107
E S _____/____/_____
NS DP CA RC
Do not write above this line.
Read this information first
Everyone should complete Parts 1, 2, and 5.
You should also complete
Amount you are paying: $__________________
• Part 3 if you believe you have overpaid
Make your check payable to “Chicago Soft Drink Tax.”
• Part 4 if you are changing financial information
Part 1: Identify your business
1
IBT no.
_____________________________________________
“X” only if address is different from the address on your original
Illinois business tax number
return and complete Item 4 below.
2
4
Tax period being amended _______________________________
Mailing address _______________________________________
Number and street
3 Business
name _______________________________________
_____________________________________________________
City
State
ZIP
Part 2: Check the reason you are correcting your return
Check any appropriate lines below.
1
3
____ I took a deduction on my original return that was not
____ I put an amount on the wrong line on Form ST-14.
4
allowed or was too large.
____ I overcollected tax from my customer.
2
5
____ I should have taken a deduction or a larger deduction
____ I made a computational error.
6
on my original return because I sold soft drinks
____ The original IBT number was incorrect. The correct IBT
a
____ to another Illinois business for resale.
number is ______________________________________.
7
(Business’ IBT no. __________________________)
____ The original liability period was incorrect. The correct
b
____ to an out-of-state customer, which was a sale
liability period is __________________________________.
8
in interstate commerce. The soft drinks were
____ Other. Please explain. _____________________________
delivered 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. ___________________________________
_______________________________________________
_________________________________________
_______________________________________________
Part 3: If you are claiming an overpayment, you must answer the following questions
1
Did you collect the overpaid tax from your customer?
______ yes
______ no
2
If you answered “yes,” did you unconditionally refund the overpayment in full? ______ yes
______ no
Please turn page over to complete Parts 4 and 5
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. This form has been approved by the Forms Management Center.
IL-492-3387
ST-14-X front (R-4/97)
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