Schedule A (Form Ds-7) - Dry-Cleaning Solvents Sold
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1Illinois Department of Revenue
Page _____ of _____
DS-7 Schedule A
Dry-Cleaning Solvents Sold
Read this information first
After you have completed this schedule, make a photocopy and retain the copy for your records; and
Attach the completed original schedule to Form DS-1, Dry-Cleaning Solvent Tax Return.
For additional instructions, see the back of Form DS-1.
Identify your business
Name: ____________________________________________
Account ID: __ __ __ __ __ __ __ __
Address: __________________________________________
License no.: DS - __ __ __ __ __
Number and street
_________________________________________________
This schedule is for the quarter ending: __ __ / __ __ __ __
City
State
ZIP
Month
Year
Describe your sales of dry-cleaning solvent
Use these abbreviations in Column B: C = Chlorine-based solvent, P = Petroleum-based solvent, G = Green solvent not used in a
virgin facility, V = Green solvent used in a virgin facility. List one type of solvent per purchaser per line.
Column A
Column B
Column C
Identify purchaser
Type of solvent sold
Number of
gallons sold
(Write license no., name, and address)
(write C, P, G, or V)
1
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
2
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
3
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
4
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
5
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
6
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
7
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
8
__ __ - __ __ __ __ __
____________________
__________________
_______________________________________________
_______________________________________________
9
9
Add the gallons in Column C , Lines 1 through 8, and write the result.
__________________
10
10
If you are filing more than one Schedule A, write the total of Line 9 from each page.
__________________
Total each solvent type and carry over to your Form DS-1 on the appropriate line.
*276001110*
DS-7 (R-10/12)
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information
is required. Failure to provide information may result in this form not being processed and may result in a penalty.
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