Fillable Form Rg-1-X - Amended Gas Tax Return printable pdf download

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Illinois Department of Revenue

REV 4

Form 424

RG-1-X

E S ___/___/___

Amended Gas Tax Return

Station no. 051

Identify your business

Account ID: ___ ___ ___ ___ ___ ___ ___ ___

License no.: ___ - ___ ___ ___ ___ ___

Check here if your address has changed.

Complete to indicate the tax period for which

Taxpayer’s name:

____________________________________________________

you are filing this return:

Month of __ __/__ __ __ __

Business name:

_____________________________________________________

Quarter ending __ __/__ __ __ __

Address: _____________________________________________________________

Year __ __ __ __

Number and street

Is this a final (you are no longer in business)

____________________________________________________________________

return?

yes

City

State

ZIP

Step 1:

Figure your receipts subject to tax - Figures as they should have been filed

Receipts (defined on instructions) from sales or purchases of gas.

___________|___

Suppliers only - Deductions (only tax-exempt receipts you included on Line 1).

Receipts from interstate commerce

___________|___

Receipts from rebillable service (sale for resale)

___________|___

Other. Explain:________________________________________________

___________|___

Suppliers only - Add Lines 2a through 2c. This is your total deduction.

___________|___

Subtract Line 3 from Line 1. This is your receipts subject to tax.

___________|___

Step 2:

Figure your therms of gas subject to tax - Figures as they should have been filed

Total therms of gas taxed on a per-therm basis.

___________|___

Suppliers only - Deductions (only tax-exempt therms you included on Line 5).

Therms of gas sold or distributed in interstate commerce

___________|___

Therms of gas to be rebilled (sale for resale)

___________|___

Other. Explain:______________________________________________

___________|___

Suppliers only - Add Lines 6a through 6c. This is your total deduction.

___________|___

Subtract Line 7 from Line 5. This amount is your therms of gas subject to tax.

___________|___

a Total therms of gas taxed on a per therm basis subject to Gas Revenue Tax.

___________|___

b Total therms of gas taxed on a per therm basis subject to Gas Use Tax.

___________|___

Step 3:

Figure your tax due - Figures as they should have been filed

Multiply Line 4 by 5% (.05). This is the tax on your receipts or purchases.

___________|___

10 a

10a

Multiply Line 8a by 2.4¢ (.024) per therm of gas. This is the Gas Revenue Tax per therms.

___________|___

10b

Multiply Line 8b by 2.4¢ (.024) per therm of gas. This is the Gas Use Tax per therms.

___________|___

Add Lines 9, 10a and 10b. This is the total gas tax due.

___________|___

Suppliers only - See instructions for Gas Use Tax discount information. Self-assessors write “0.”

___________|___

Subtract Line 12 from Line 11. This is your tax due.

___________|___

If you pay on a quarter-monthly basis, write the amount you paid in estimated payments. If not, write “0.”

___________|___

If Line 14 is greater than Line 13, figure your overpayment by subtracting Line 13 from Line 14. Go to Step 4.

___________|___

If Line 14 is less than Line 13, figure your underpayment by subtracting Line 14 from Line 13.

___________|___

Write the total credit you wish to apply.

___________|___

Subtract Line 17 from Line 16 - This is your net tax due.

___________|___

Total amount that you have paid for this reporting period.

___________|___

If Line 19 is greater than Line 18, figure your overpayment by subtracting Line 18 from Line 19.

___________|___

If Line 19 is less than Line 18, figure your underpayment by subtracting Line 19 from Line 18.

Pay this amount and make your check payable to “Illinois Department of Revenue.”

___________|___

Step 4:

Check the reason you are filing this amended return

❑

I received a Notice of Possible Overpayment or made a computation error that resulted in an overpayment of tax.

• If you checked this box, did you collect the overpaid tax from your customer?

yes

• If you checked “yes,” did you unconditionally refund the overpaid tax?

yes

❑

I made a computation error that resulted in underpayment of tax.

❑

I made an error on a schedule or attachment.

❑

I should have taken a deduction for____________________________________________________________________________.

❑

The original License no. was incorrect. The incorrect License no. is G - __ __ __ __ __.

❑

The original reporting period was incorrect. The incorrect reporting period is ___________________________.

❑

Other. Please explain_ ______________________________________________________________________________________

Step 5:

Sign below

Under penalties of perjury, I state that I have examined this return and, to the best of my knowledge, it is true, correct, and complete.

_____________________________

________________________ (____)____-___________

____/____/________

Title:

Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title)

Telephone number (include area code)

Date

_____________________________

________________________ (____)____-___________

____/____/________

Firm:

Preparer’s signature and name of the firm or employer (if applicable)

Telephone number (include area code)

Date

This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed.

*242401110*

Disclosure of this information is required. Failure to provide information may result in this form not being

processed and may result in a penalty.

RG-1-X (R-11/12)

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Form Rg-1-X - Amended Gas Tax Return

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