Form Rc-6-A-X - Amended Out-Of-State Cigarette And Little Cigar Revenue Return
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1Illinois Department of Revenue
REV 01 FORM 435
E S ___/___/___
RC-6-A-X
NS
DP
CA
Amended Out-of-State Cigarette and Little Cigar Revenue Return
Do not write above this line.
Read this information first
Station no. 067
Do not send any payment with Form RC-6-A-X. Attach all necessary schedules and keep a copy for your records.
Step 1: Identify your business
1
5
Account ID: ____ ____ ____ ____ ____ ____ ____ ____
For what tax period are you filing this return?
Month/Year: ___ ___/___ ___ ___ ___
2
License no.: U - ___ ___ ___ ___ ___
3
6
Business name: ________________________________________________________
Check here if your address has changed.
4
7
Business address: ______________________________________________________
Is this a final (you are no longer in business)
Number and street
return?
yes
no
_______________________________________________________________________
City
State
ZIP
Step 2: Report your stock -
Figures as they should have been reported
Number of sticks
,
,
,
8
8
Total purchase of Illinois stamped cigarettes and little cigars from another licensed distributor (Sch. CC)
______
_________
_________
_________
,
,
,
9
9
Total of Illinois stamped cigarettes and little cigars returned to manufacturers
______
_________
_________
_________
,
,
,
10
10
Total of other deductions (Sch. CH)
______
_________
_________
_________
,
,
,
11
11
Total of unstamped/non-Illinois stamped cigarettes and little cigars shipped into Illinois (Sch. CK)
______
_________
_________
_________
,
,
,
12
12
Net total of Illinois stamped cigarettes and little cigars shipped into Illinois (Sch. CL)
______
_________
_________
_________
13
Multiply Line 12 by appropriate mill rate. This is the value of Illinois stamps affixed
13 $
to cigarettes and little cigars you sold.
__________________________________
Step 3: Report your Illinois cigarette tax stamp usage -
Figures as they should have been reported
Dollar value
14
14 $
Value of all stamps on hand at the beginning of the month
__________________________________
15
15 $
Value of unaffixed stamps transferred from another licensed distributor
__________________________________
16
16 $
Value of stamps purchased during the month (Sch. CF-1, Step 2)
__________________________________
17
17 $
Multiply Step 2, Line 8, by appropriate mill rate. This is the value of stamps affixed when purchased.
__________________________________
18
Add Lines 14 thru 17. This is the value of stamps on hand at the beginning
of the month plus purchases made during the month.
18 $
__________________________________
19
19 $
Value of unaffixed stamps transferred to another licensed distributor
__________________________________
20
20 $
Value of stamps returned for credit
__________________________________
21
21 $
Add Lines 19 and 20. This is your total deductions.
__________________________________
22
22 $
Subtract Line 21 from Line 18. This is the total value of stamps to be accounted for.
__________________________________
23
23 $
Value of all affixed stamps on hand at the end of the month (Sch. CF, Part 3a)
__________________________________
24
24 $
Value of all unaffixed stamps on hand at the end of the month (Sch. CF, Part 3b)
__________________________________
25
25 $
Add Lines 23 and 24. This is the value of all stamps on hand at the end of the month.
__________________________________
26
26 $
Subtract Line 25 from Line 22. This is the value of affixed stamps sold during the month.
__________________________________
Step 4: Mark the reason why you are filing an amended return
I made an error on a schedule or attachment.
I should have taken a deduction for______________________________________________________________________________.
I need to correct the license number on a previously filed return. The incorrect license number was U - ___ ___ ___ ___ ___.
I need to correct the reporting period on a previously filed return. The incorrect reporting period was __________________________.
Other. Please explain. ______________________________________________________________________________________
Step 5: Sign below
Under penalties of perjury, I state that I have examined this return and all accompanying schedules and, to the best of my knowledge, it is
true, correct, and complete. I also state that such information is taken from the books and records of the business for which this return is filed.
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Owner or officer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Preparer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
RC-6-A-X (R-07/13)
*343511110*
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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