Form Rc-55-X - Amended Unstamped Little Cigar Sticks Tax Return

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Illinois Department of Revenue
REV 01 FORM 94B
E S
_ _/_ _/_ _ _ _
RC-55-X
NS
DP
CA
RC
Amended Unstamped Little Cigar Sticks Tax Return
(Not in packages of 20 or 25)
Station no. 592 (Out-of-state: Station no. 599)
Do not write above this line.
Step 1:
Identify your business
1
5
Account ID: ____ ____ ____ ____ ____ ____ ____ ____
For what tax period are you filing this return?
___ ___/___ ___ ___ ___
Month
Year
2
License no.: ___ ___- ___ ___ ___ ___ ___
6
Check if your address has changed.
3
Business name: ______________________________________________________
7
Is this a final (you are no longer in
4
Business address: ____________________________________________________
business) return?
yes
no
Number and street
___________________________________________________________________
Check here if your license number
City
State
ZIP
begins with a "U".
Figures as they should
Step 2: Figure your tax due
have been reported
8
Enter the total number of little cigar sticks sold in unstamped packages containing any
8
quantity other than 20 or 25 sticks for the reporting period.
___________________
9
9
Multiply Line 8 by 99 mills ($0.099).
$__________________
10
10
Discount
$__________________
11
11
Subtract Line 10 from Line 9. This is the tax due.
$__________________
12
12
Excess tax collected
$__________________
13
13
Add Line 11 and Line 12. This is the total tax due.
$__________________
14
14
Credit you wish to apply
$__________________
15
15
Subtract Line 14 from Line 13. This is your net tax due.
$__________________
16
16
Total amount you paid for this reporting period.
$__________________
17
17
If Line 16 is greater than Line 15, figure your overpayment by subtracting Line 15 from Line 16.
$__________________
18
18
If Line 16 is less than Line 15, figure your underpayment by subtracting Line 16 from Line 15.
$__________________
Pay this amount and make your check payable to “Illinois Department of Revenue.”
Step 3:
Mark the reason why you are filing an amended return
I received a Notice of Possible Overpayment or made a computation error that resulted in an overpayment of tax.
I made a computation error that resulted in underpayment of tax.
I need to correct the license number on a previously filed return. The incorrect license number was __ __ - __ __ __ __ __.
I need to correct the reporting period on a previously filed return. The incorrect reporting period was ____________________________.
Other. Please explain. _________________________________________________________________________________________
___________________________________________________________________________________________________________
Step 4:
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.
___________________________________________________
____________
____/____/________ (____)____-____________
Taxpayer's signature
Title
Date
Telephone (Include area code)
___________________________________________________
____________
____/____/________ (____)____-____________
Preparer's signature
Title
Date
Telephone (Include area code)
Step 5:
Mail your completed return and payment to:
*394B11110*
ALCOHOL, TOBACCO AND FUEL DIVISION
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
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.
RC-55-X (R-07/13)

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