Form Rb-1-L - Limited Bingo Tax Return
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1
2Illinois Department of Revenue
RB-1-L
Limited Bingo Tax Return
Do not write above this line.
Step 1: Identify your organization
Bingo license no. BL –___________________________________
Event date: from ____/____/____ to ____/____/____
Organization name _____________________________________
Total games held_______________________________________
Address______________________________________________
Is this an amended return?
___ yes
___ no
Number and street
________________________________________________________________
Sequence number______________________________________
City
State
ZIP
Step 2: Identify your supplier
Did you purchase any bingo supplies or equipment for this event?
___ yes ___ no
If "yes," complete the following information:
Supplier's license no. BF– ________________________________
Supplier's license no. BF– ________________________________
Supplier's name________________________________________
Supplier's name _______________________________________
Address______________________________________________
Address______________________________________________
Number and street
Number and street
_____________________________________________________
____________________________________________________
City
State
ZIP
City
State
ZIP
Step 3: Figure your tax due
Value of
prizes awarded
No. of players
Gross proceeds
1
1
Total prizes, players, and gross proceeds for your bingo event
____________|__
_____________
__________|__
2
2
Multiply Line 1, Gross proceeds column, by 5% (.05). This is the bingo tax due.
__________|__
3
Total credit you wish to apply
Credit number
__________ __________ __________
3
Credit amount
________|__ ________|__ ________|__
__________|__
4
4
Subtract Line 3 from Line 2. Please pay this amount.
__________|__
Make your check payable to "Illinois Department of Revenue."
Step 4: Sign below
Under penalties of perjury, I state that I have examined this return and that it is true, correct, and complete, and that the total
value of the prizes or merchandise awarded on any day was not greater than $2,250 ($3,250 in Madison, Monroe, and St. Clair
counties and the City of Red Bud.)
__________________________________________________________(_____)_________________________________________________
Officer's signature
Phone
Date
__________________________________________________________(_____)_________________________________________________
Paid tax preparer's signature
Phone
Date
Mail this return and your payment to:
BINGO TAX
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
This form is authorized by the Illinois Bingo License and Tax Act. 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-492-2715
RB-1-L front (R-12/00)
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