Form St-2-X - Amended Multiple Site Form

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Illinois Department of Revenue
ST-2-X
Amended Multiple Site Form
Attach to Form ST-1-X.
REV
001
FORM
010
Do not write above this line.
Business name: ___________________________________
Account ID:
____ ____ ____ ____ - ____ ____ ____ ____
Reporting period you are amending:
__ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __
Month
Day
Year
Month
Day
Year
Write the fi gures that should have been fi led. You must round your fi gures to whole dollars.
Base (a) X rate = tax (b)
Site where taxable sales were made
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
General merchandise
Location code
_____________________________________
4a _______________
X _______ = 4b ________________
Site name
_____________________________________
(rate)
Food, drugs, and medical appliances
Site address
_____________________________________
5a _______________
X _______ = 5b ________________
_____________________________________
(rate)
Receipts taxed at other rates
City, state, ZIP
_____________________________________
8a _______________
8b ________________
This form is authorized as outlined by the Retailers’ Occupation Tax Act and related 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-492-2736
SOY-BASE INK
ST-2-X (R-5/09)
RECYCLED PAPER
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