Form St-1-X - Amended Sales And Use Tax And E911 Surcharge Return - 2016 Page 4

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Account ID: ____ ____ ____ ____ - ____ ____ ____ ____
Reporting period you are amending: __ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __
Month Day
Year
Month
Day
Year
Column B
Column A
Schedule B-X — Amended E911 Surcharge and ITAC Assessment
Figures as they
Most recent
should have been filed
figures filed
Receipts from retail transactions of prepaid wireless telecommunications service
1
1
Enter receipts subject to E911 Surcharge and ITAC Assessment
_____________|_____ _____________|_____
Figure your breakdown of retail transactions for Chicago locations
2
2a
For Chicago locations
_____________|_____ _____________|_____
2b
Multiply Line 2a by your rate of _______.
_____________|_____ _____________|_____
3
3a
For Chicago locations at prior rates
_____________|_____ _____________|_____
3b
Multiply Line 3a by your rate of _______.
_____________|_____ _____________|_____
4
4
Total for Chicago. Add Lines 2b and 3b.
_____________|_____ _____________|_____
Figure your breakdown of retail transactions for non-Chicago locations
5
5a
For non-Chicago locations
_____________|_____ _____________|_____
5b
Multiply Line 5a by your rate of _______.
_____________|_____ _____________|_____
6
6a
For non-Chicago locations at prior rates
_____________|_____ _____________|_____
6b
Multiply Line 6a by your rate of _______.
_____________|_____ _____________|_____
7
7
Total for non-Chicago locations. Add Lines 5b and 6b.
_____________|_____ _____________|_____
Figure your net E911 Surcharge and ITAC Assessment
8
8
Total E911 Surcharge and ITAC Assessment. Add Lines 4 and 7.
_____________|_____ _____________|_____
9
9
If you filed and paid by the due date, multiply Line 8 by _______. See instructions.
_____________|_____ _____________|_____
10
10
Subtract Line 9 from Line 8. Enter these amounts on Step 4, Line 21.
_____________|_____ _____________|_____
Reset
Print
*600354110*
ST-1-X (R-06/16)

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