Illinois Department of Revenue
REV 01 FORM 445
RC-13
Schedule CK
Shipments of Unstamped Cigarettes and Little Cigars into Illinois
Read this information first
Sheet no. __________
As a distributor located outside of Illinois, you must report on this schedule all shipments of unstamped cigarettes and little
cigars you made to licensed distributors in Illinois.
Attach a completed schedule to Form RC-6-A, Out-of-State Cigarette and Little Cigar Revenue Return, and keep a copy for
your records.
For additional instructions, see Form RC-6-A.
Step 1: Identify your business
Name _ _ ___________________________________________ Account ID: __ __ __ __ __ __ __ __
Address _ __________________________________________ License no.: U - ___ ___ ___ ___ ___
Number and street
_ _________________________________________________ Tax period __ __ / __ __ __ __
City
State
ZIP
Month
Year
Step 2: Identify your sales
FEIN of
Name of distributor to
Address of distributor to whom
Date
Invoice no. distributor to whom
whom you shipped
you shipped cigarettes or
Number of sticks
you sold cigarettes
cigarettes or
little cigars
or little cigars
little cigars
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,
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*344511110*
Page total
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Grand total
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RC-13 (R-07/13) Schedule CK
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.